Extranodal tumor deposits in the axillary fat indicate the need for axillary dissection among T1–T2cN0 patients with positive sentinel nodes Journal Article


Authors: Mamtani, A.; Barrio, A. V.; Goldman, D. A.; Wen, H. Y.; Vincent, A.; Morrow, M.
Article Title: Extranodal tumor deposits in the axillary fat indicate the need for axillary dissection among T1–T2cN0 patients with positive sentinel nodes
Abstract: Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated the safety of omitting axillary lymph node dissection (ALND) in T1–T2cN0 patients with fewer than three positive sentinel nodes (SLNs) undergoing breast-conservation therapy. While microscopic extracapsular extension (mECE) > 2 mm is associated with increased nodal burden, the significance of extranodal tumor deposits (ETDs) in the axillary fat is uncertain. Methods: Consecutive patients with T1–T2cN0 breast cancer undergoing sentinel node biopsy and ALND for SLN metastases from January 2010 to December 2018 were identified. ETDs were defined as intravascular tumor emboli or metastatic deposits in the axillary fat. Clinicopathologic characteristics and nodal burden were compared by ETD status. Results: Among 1114 patients, 113 (10%) had ETDs: 81 (72%) were intravascular tumor emboli and 32 (28%) were soft tissue deposits. Patients with ETDs had larger tumors (median 2.2 vs. 2.1 cm; p = 0.033) and more often had mECE (83% vs. 44%; p < 0.001). On univariable analysis, presence of ETDs (odds ratio [OR] 9.66, 95% confidence interval [CI] 6.36–14.68), larger tumors (OR 1.47, 95% CI 1.25–1.72), and mECE (OR 10.73, 95% CI 6.86–16.78) were associated with four or more additional positive non-SLNs (NSLNs; all p < 0.001). On multivariable analysis, ETDs remained associated with four or more positive NSLNs (OR 5.67, 95% CI 3.53–9.08; p < 0.001). ETDs were strongly associated with four or more positive NSLNs (OR 7.15, 95% CI 4.04–12.67) among patients with one to two positive SLNs (n = 925). Conclusions: Among T1–T2cN0 patients with SLN metastases, ETDs are strongly associated with four or more positive NSLNs at ALND. Even among those who may otherwise meet the criteria for omission of ALND, the presence of ETDs in axillary fat warrants consideration of ALND. © 2020, Society of Surgical Oncology.
Keywords: adult; human tissue; aged; young adult; major clinical study; lymph node dissection; sentinel lymph node biopsy; breast cancer; tumor volume; risk factor; soft tissue; axillary lymph node; vascular tumor; tumor embolism; body fat; lymph vessel metastasis; sentinel lymph node metastasis; extranodal extension; very elderly; human; female; article
Journal Title: Annals of Surgical Oncology
Volume: 27
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2020-10-01
Start Page: 3585
End Page: 3592
Language: English
DOI: 10.1245/s10434-020-08632-1
PUBMED: 32488512
PROVIDER: scopus
PMCID: PMC8299901
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Andrea Veronica Barrio
    130 Barrio
  2. Monica Morrow
    766 Morrow
  3. Hannah Yong Wen
    294 Wen
  4. Alain M Vincent
    20 Vincent
  5. Debra Alyssa Goldman
    157 Goldman
  6. Anita   Mamtani
    64 Mamtani