The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer Journal Article


Authors: Gooch, J.; King, T. A.; Eaton, A.; Dengel, L.; Stempel, M.; Corben, A. D.; Morrow, M.
Article Title: The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer
Abstract: Background. Whether extracapsular extension (ECE) of tumor in the sentinel lymph node (SLN) is an indication for axillary lymph node dissection (ALND) in patients managed by American College of Surgeons Oncology Group Z0011 criteria is controversial. Here we examine the correlation between ECE in the SLN and disease burden in the axilla. Methods. Patients meeting Z0011 clinicopathologic criteria (pT1-2, cN0 with <3 positive SLNs) were selected from a prospectively maintained database (2006-2013). Chart review documented the presence and extent of ECE. Neoadjuvant chemotherapy patients were excluded. Comparisons were made by presence and extent (≥2 vs. >2 mm) of ECE. Results. Of 11,730 patients, 778 were pT1-2, cN0 with <3 positive SLNs without ECE, and 331 (2.8 %) had ECE. Of these, 180 had ≤2 mm and 151 had >2 mm of ECE. Patients with ECE were older (57 vs. 54 years; p = 0.001) and had larger (2.0 vs. 1.7 cm; p < 0.0001), multifocal (p = 0.006), hormone receptor-positive tumors (p = 0.0164) with lymphovascular invasion (p < 0.0001). Presence and extent of ECE were associated with greater axillary disease burden; 20 and 3 % of patients with and without ECE, respectively, had ≥4 additional positive nodes at completion ALND (p < 0.0001), and 33 % of patients with >2 mm ECE had ≥4 additional positive nodes at completion ALND, compared with 9 % in the <2 mm group (p < 0.0001). On multivariate analysis, >2 mm of ECE was the strongest predictor of ≥4 positive nodes at completion ALND (odds ratio 14.2). Conclusions. Presence and extent of ECE were significantly correlated with nodal tumor burden at completion ALND, thus suggesting that >2 mm of ECE may be an indication for ALND or radiotherapy when applying Z0011 criteria to patients with metastases in <3 SLNs. ECE reporting should be standardized to facilitate future studies. © 2014 Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 21
Issue: 9
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2014-09-01
Start Page: 2897
End Page: 2903
Language: English
DOI: 10.1245/s10434-014-3752-0
PROVIDER: scopus
PUBMED: 24777858
PMCID: PMC4346337
DOI/URL:
Notes: Export Date: 2 September 2014 -- CODEN: ASONF -- Source: Scopus
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MSK Authors
  1. Monica Morrow
    629 Morrow
  2. Adriana Dionigi Corben
    64 Corben
  3. Tari King
    177 King
  4. Anne Austin Eaton
    122 Eaton
  5. Michelle Moccio Stempel
    153 Stempel
  6. Jessica Charlotte Gooch
    6 Gooch