The value of level III clearance in patients with axillary and sentinel node positive breast cancer.

Hdl Handle:
http://hdl.handle.net/10147/207584
Title:
The value of level III clearance in patients with axillary and sentinel node positive breast cancer.
Authors:
Dillon, Mary F; Advani, Vriti; Masterson, Catherine; O'Loughlin, Christina; Quinn, Cecily M; O'Higgins, Niall; Evoy, Denis; McDermott, Enda W
Affiliation:
Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. maryfdillon@hotmail.com
Citation:
Ann Surg. 2009 May;249(5):834-9.
Journal:
Annals of surgery
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207584
DOI:
10.1097/SLA.0b013e3181a40821
PubMed ID:
19387317
Abstract:
BACKGROUND: The value of level III axillary clearance is contentious, with great variance worldwide in the extent and levels of clearance performed. OBJECTIVE: To determine rates of level III positivity in patients undergoing level I-III axillary clearance, and identify which patients are at highest risk of involved level III nodes. METHODS: From a database of 2850 patients derived from symptomatic and population-based screening service, 1179 patients who underwent level I-III clearance between the years 1999-2007 were identified. The pathology, surgical details, and prior sentinel nodes biopsies of patients were recorded. RESULTS: Eleven hundred seventy nine patients had level I-III axillary clearance. Of the patients, 63% (n = 747) were node positive. Of patients with node positive disease, 23% (n = 168) were level II positive and 19% (n = 141) were level III positive. Two hundred fifty patients had positive sentinel node biopsies prior to axillary clearance. Of these, 12% (n = 30) and 9% (n = 22) were level II and level III positive, respectively. On multivariate analysis, factors predictive of level III involvement in patients with node positive disease were tumor size (P < 0.001, OR = 1.36; 95% CI: 1.2-1.5), invasive lobular disease (P < 0.001, OR = 3.6; 95% CI: 1.9-6.95), extranodal extension (P < 0.001, OR = 0.27; 95% CI: 0.18-0.4), and lymphovascular invasion (P = 0.04, OR = 0.58; 95% CI: 0.35-1). Lobular invasive disease (P = 0.049, OR = 4.1; 95% CI: 1-16.8), extranodal spread (P = 0.003, OR = 0.18; 95% CI: 0.06-0.57), and having more than one positive sentinel node (P = 0.009, OR = 4.9; 95% CI: 1.5-16.1) were predictive of level III involvement in patients with sentinel node positive disease. CONCLUSION: Level III clearance has a selective but definite role to play in patients who have node positive breast carcinoma. Pathological characteristics of the primary tumor are of particular use in identifying those who are at various risk of level III nodal involvement.
Language:
eng
MeSH:
Axilla/pathology/*surgery; Breast Neoplasms/*pathology; Female; Humans; *Lymph Node Excision; Lymph Nodes/pathology/*surgery; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; *Sentinel Lymph Node Biopsy
ISSN:
1528-1140 (Electronic); 0003-4932 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorDillon, Mary Fen_GB
dc.contributor.authorAdvani, Vritien_GB
dc.contributor.authorMasterson, Catherineen_GB
dc.contributor.authorO'Loughlin, Christinaen_GB
dc.contributor.authorQuinn, Cecily Men_GB
dc.contributor.authorO'Higgins, Niallen_GB
dc.contributor.authorEvoy, Denisen_GB
dc.contributor.authorMcDermott, Enda Wen_GB
dc.date.accessioned2012-02-01T10:32:04Z-
dc.date.available2012-02-01T10:32:04Z-
dc.date.issued2012-02-01T10:32:04Z-
dc.identifier.citationAnn Surg. 2009 May;249(5):834-9.en_GB
dc.identifier.issn1528-1140 (Electronic)en_GB
dc.identifier.issn0003-4932 (Linking)en_GB
dc.identifier.pmid19387317en_GB
dc.identifier.doi10.1097/SLA.0b013e3181a40821en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207584-
dc.description.abstractBACKGROUND: The value of level III axillary clearance is contentious, with great variance worldwide in the extent and levels of clearance performed. OBJECTIVE: To determine rates of level III positivity in patients undergoing level I-III axillary clearance, and identify which patients are at highest risk of involved level III nodes. METHODS: From a database of 2850 patients derived from symptomatic and population-based screening service, 1179 patients who underwent level I-III clearance between the years 1999-2007 were identified. The pathology, surgical details, and prior sentinel nodes biopsies of patients were recorded. RESULTS: Eleven hundred seventy nine patients had level I-III axillary clearance. Of the patients, 63% (n = 747) were node positive. Of patients with node positive disease, 23% (n = 168) were level II positive and 19% (n = 141) were level III positive. Two hundred fifty patients had positive sentinel node biopsies prior to axillary clearance. Of these, 12% (n = 30) and 9% (n = 22) were level II and level III positive, respectively. On multivariate analysis, factors predictive of level III involvement in patients with node positive disease were tumor size (P < 0.001, OR = 1.36; 95% CI: 1.2-1.5), invasive lobular disease (P < 0.001, OR = 3.6; 95% CI: 1.9-6.95), extranodal extension (P < 0.001, OR = 0.27; 95% CI: 0.18-0.4), and lymphovascular invasion (P = 0.04, OR = 0.58; 95% CI: 0.35-1). Lobular invasive disease (P = 0.049, OR = 4.1; 95% CI: 1-16.8), extranodal spread (P = 0.003, OR = 0.18; 95% CI: 0.06-0.57), and having more than one positive sentinel node (P = 0.009, OR = 4.9; 95% CI: 1.5-16.1) were predictive of level III involvement in patients with sentinel node positive disease. CONCLUSION: Level III clearance has a selective but definite role to play in patients who have node positive breast carcinoma. Pathological characteristics of the primary tumor are of particular use in identifying those who are at various risk of level III nodal involvement.en_GB
dc.language.isoengen_GB
dc.subject.meshAxilla/pathology/*surgeryen_GB
dc.subject.meshBreast Neoplasms/*pathologyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.mesh*Lymph Node Excisionen_GB
dc.subject.meshLymph Nodes/pathology/*surgeryen_GB
dc.subject.meshLymphatic Metastasisen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNeoplasm Stagingen_GB
dc.subject.mesh*Sentinel Lymph Node Biopsyen_GB
dc.titleThe value of level III clearance in patients with axillary and sentinel node positive breast cancer.en_GB
dc.contributor.departmentDepartment of Surgery, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. maryfdillon@hotmail.comen_GB
dc.identifier.journalAnnals of surgeryen_GB
dc.description.provinceLeinster-

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