ORIGINAL ARTICLE

Factors affecting metastases to non-sentinel lymph nodes in breast cancer

F J Fleming, D Kavanagh, T B Crotty, C M Quinn, E W McDermott, N O’Higgins and A D K Hill

Departments of Surgery and Pathology, St Vincent’s University Hospital and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland

Correspondence to:
Correspondence to:
Mr A D K Hill
St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; adkhill{at}ucd.ie

Aims: Because sentinel lymph node (SLN) biopsy for breast cancer has become well established, one of the challenges now is to determine which patients require a completion axillary dissection following a positive SLN biopsy.

Methods: A prospective database of patients who underwent SLN biopsy for invasive breast cancer from July 1999 to November 2002 (n = 180) was analysed. Fifty four patients (30%) had one or more positive SLN, and all underwent a completion axillary dissection. This subgroup was further analysed to delineate which factors predicted non-SLN metastasis.

Results: Twenty six of the 54 patients with a positive SLN had additional metastases in non-SLNs. Significant variables that predicted non-SLN metastasis included extranodal extension (odds ratio (OR), 17.399; 95% confidence interval (CI), 1.69 to 178.96) and macrometastasis within the SLN (OR, 6.985; 95% CI, 1.291 to 37.785).

Conclusions: In patients with invasive breast cancer and a positive SLN, extranodal extension or macrometastasis within the SLN were both independent predictors of non-SLN involvement.

Keywords: metastasis; breast cancer; sentinel node

Abbreviations: ALND, axillary lymph node dissection; H&E, haematoxylin and eosin; LVI, lymphovascular invasion; SLN, sentinel lymph node

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