Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes
Background and Objectives: The diagnostic and therapeutic significance of axillary dissection has been questioned. We sought to define a subgroup of patients with early‐stage breast cancer who are at low risk for positive axillary nodes. Methods Between 1970 and 1995, 1,598 women with stage I and II...
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| Veröffentlicht in: | Journal of surgical oncology 1997-05, Vol.65 (1), p.34-39 |
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| creator | Fein, Douglas A. Fowble, Barbara L. Hanlon, Alexandra L. Hooks, Mary A. Hoffman, John P. Sigurdson, Elin R. Jardines, Lori A. Eisenberg, Burton L. |
| description | Background and Objectives: The diagnostic and therapeutic significance of axillary dissection has been questioned. We sought to define a subgroup of patients with early‐stage breast cancer who are at low risk for positive axillary nodes.
Methods
Between 1970 and 1995, 1,598 women with stage I and II breast cancer underwent level I‐II axillary dissection with a minimum of 10 nodes removed. The following factors were examined in univariate analysis for predicting positive nodes: race, method of detection, location of the primary tumor, age, menopausal status, obesity, ER status, PR status, pathologic tumor size, lymphatic vascular invasion, tumor grade, and histology.
Results
Four hundred and forty‐five of the 1,598 patients (27.8%) had histologically positive axillary nodes. Significant factors in univariate analysis for positive nodes included: tumor size, lymphatic vascular invasion, grade, method of detection, primary tumor location, and age. The only group of women with a 0% risk of axillary nodes were those in whom the pathologic tumor size was ≤5 mm and mammographically detected. A 5‐10% risk of positive axillary nodes was identified in women with (1) pathologic tumor size 6‐10 mm, mammographically detected, and age ≤40 years, and (2) tubular carcinoma ≤10 mm. Tumors detected on physical examination with or without mammography and women ≤40 years had a significantly increased risk of nodes. In multivariate analysis lymphatic vascular invasion (P 40 and (3) tubular carcinoma ≤10 mm. All other groups had a >10% risk of nodes and may benefit from axillary dissection. J. Surg. Oncol. 1997;65:34‐39. © 1997 Wiley‐Liss, Inc. |
| doi_str_mv | 10.1002/(SICI)1096-9098(199705)65:1<34::AID-JSO7>3.0.CO;2-P |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_79036201</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>79036201</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4257-69fe836055e4e8a38bdb45f25778cb0e7abac2f97ba3d6d7e23941943addea893</originalsourceid><addsrcrecordid>eNp9kF1v0zAYhS0EGmXwE5B8gdB2kc4fiR13E9IUYHSaaKUWJnHzykneCLM0KXFKt3-PQ6vuAsSVZZ2jx8cPIeecjTlj4uxkMc2mp5wZFRlm0hNujGbJqUom_ELGk8nl9H10vZjpd3LMxtnsXETzJ2R06D8lo0ARUawNe05eeP-DMWaMio_IkeHaCJWMyO20xKZ3lSts79qGthXdtits6Nb13-mSR0tB8w6t72lhmwI7antat1vaOX83tNetd737hdTeu7q23QNt2hL9S_KssrXHV_vzmHz5-GGZfYpuZlfT7PImKmKR6EiZClOpWJJgjKmVaV7mcVKFSKdFzlDb3BaiMjq3slSlRiFNzE0sbVmiTY08Jm933HXX_tyg72HlfIFhSYPtxkP4u1SC8VBc7IpF13rfYQXrzq3CXuAMBt0Ag24Y9MGgD3a6QSXAQcYAQTcMukECg2wGAuaB-nr__CZfYXlg7v2G_M0-t76wddUFh84fakIZoTV7HLd1NT78tez_w_6x6889UKMd1fke7w9U292B0lIncPv5CtQ3cz3_mqag5G9Y77Xz</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>79036201</pqid></control><display><type>article</type><title>Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><creator>Fein, Douglas A. ; Fowble, Barbara L. ; Hanlon, Alexandra L. ; Hooks, Mary A. ; Hoffman, John P. ; Sigurdson, Elin R. ; Jardines, Lori A. ; Eisenberg, Burton L.</creator><creatorcontrib>Fein, Douglas A. ; Fowble, Barbara L. ; Hanlon, Alexandra L. ; Hooks, Mary A. ; Hoffman, John P. ; Sigurdson, Elin R. ; Jardines, Lori A. ; Eisenberg, Burton L.</creatorcontrib><description>Background and Objectives: The diagnostic and therapeutic significance of axillary dissection has been questioned. We sought to define a subgroup of patients with early‐stage breast cancer who are at low risk for positive axillary nodes.
Methods
Between 1970 and 1995, 1,598 women with stage I and II breast cancer underwent level I‐II axillary dissection with a minimum of 10 nodes removed. The following factors were examined in univariate analysis for predicting positive nodes: race, method of detection, location of the primary tumor, age, menopausal status, obesity, ER status, PR status, pathologic tumor size, lymphatic vascular invasion, tumor grade, and histology.
Results
Four hundred and forty‐five of the 1,598 patients (27.8%) had histologically positive axillary nodes. Significant factors in univariate analysis for positive nodes included: tumor size, lymphatic vascular invasion, grade, method of detection, primary tumor location, and age. The only group of women with a 0% risk of axillary nodes were those in whom the pathologic tumor size was ≤5 mm and mammographically detected. A 5‐10% risk of positive axillary nodes was identified in women with (1) pathologic tumor size 6‐10 mm, mammographically detected, and age ≤40 years, and (2) tubular carcinoma ≤10 mm. Tumors detected on physical examination with or without mammography and women ≤40 years had a significantly increased risk of nodes. In multivariate analysis lymphatic vascular invasion (P <0.001), method of detection (P = 0.026), location (P = 0.01), and pathologic tumor size (P = 0.002) were significant predictors of positive axillary lymphadenopathy.
Conclusions
The decision to forego an axillary dissection should be considered in (1) tumors mammographically detected and ≤5 mm (2) mammographically detected, pathologic size 6‐10 mm, age >40 and (3) tubular carcinoma ≤10 mm. All other groups had a >10% risk of nodes and may benefit from axillary dissection. J. Surg. Oncol. 1997;65:34‐39. © 1997 Wiley‐Liss, Inc.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/(SICI)1096-9098(199705)65:1<34::AID-JSO7>3.0.CO;2-P</identifier><identifier>PMID: 9179265</identifier><identifier>CODEN: JSONAU</identifier><language>eng</language><publisher>New York: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adult ; Axilla ; axillary lymphadenopathy ; Biological and medical sciences ; breast conservation surgery ; Breast Neoplasms - chemistry ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Carcinoma, Ductal, Breast - chemistry ; Carcinoma, Ductal, Breast - pathology ; Carcinoma, Ductal, Breast - surgery ; Carcinoma, Lobular - chemistry ; Carcinoma, Lobular - pathology ; Carcinoma, Lobular - surgery ; Female ; Gynecology. Andrology. Obstetrics ; Humans ; Lymph Node Excision ; Lymph Nodes - pathology ; Lymphatic Metastasis ; Mammary gland diseases ; Medical sciences ; Middle Aged ; Neoplasm Staging ; Prognosis ; prognostic factors ; Receptors, Estrogen - metabolism ; Risk ; Tumors</subject><ispartof>Journal of surgical oncology, 1997-05, Vol.65 (1), p.34-39</ispartof><rights>Copyright © 1997 Wiley‐Liss, Inc.</rights><rights>1997 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4257-69fe836055e4e8a38bdb45f25778cb0e7abac2f97ba3d6d7e23941943addea893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2F%28SICI%291096-9098%28199705%2965%3A1%3C34%3A%3AAID-JSO7%3E3.0.CO%3B2-P$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2F%28SICI%291096-9098%28199705%2965%3A1%3C34%3A%3AAID-JSO7%3E3.0.CO%3B2-P$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,1411,23909,23910,25118,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2692770$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9179265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fein, Douglas A.</creatorcontrib><creatorcontrib>Fowble, Barbara L.</creatorcontrib><creatorcontrib>Hanlon, Alexandra L.</creatorcontrib><creatorcontrib>Hooks, Mary A.</creatorcontrib><creatorcontrib>Hoffman, John P.</creatorcontrib><creatorcontrib>Sigurdson, Elin R.</creatorcontrib><creatorcontrib>Jardines, Lori A.</creatorcontrib><creatorcontrib>Eisenberg, Burton L.</creatorcontrib><title>Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes</title><title>Journal of surgical oncology</title><addtitle>J. Surg. Oncol</addtitle><description>Background and Objectives: The diagnostic and therapeutic significance of axillary dissection has been questioned. We sought to define a subgroup of patients with early‐stage breast cancer who are at low risk for positive axillary nodes.
Methods
Between 1970 and 1995, 1,598 women with stage I and II breast cancer underwent level I‐II axillary dissection with a minimum of 10 nodes removed. The following factors were examined in univariate analysis for predicting positive nodes: race, method of detection, location of the primary tumor, age, menopausal status, obesity, ER status, PR status, pathologic tumor size, lymphatic vascular invasion, tumor grade, and histology.
Results
Four hundred and forty‐five of the 1,598 patients (27.8%) had histologically positive axillary nodes. Significant factors in univariate analysis for positive nodes included: tumor size, lymphatic vascular invasion, grade, method of detection, primary tumor location, and age. The only group of women with a 0% risk of axillary nodes were those in whom the pathologic tumor size was ≤5 mm and mammographically detected. A 5‐10% risk of positive axillary nodes was identified in women with (1) pathologic tumor size 6‐10 mm, mammographically detected, and age ≤40 years, and (2) tubular carcinoma ≤10 mm. Tumors detected on physical examination with or without mammography and women ≤40 years had a significantly increased risk of nodes. In multivariate analysis lymphatic vascular invasion (P <0.001), method of detection (P = 0.026), location (P = 0.01), and pathologic tumor size (P = 0.002) were significant predictors of positive axillary lymphadenopathy.
Conclusions
The decision to forego an axillary dissection should be considered in (1) tumors mammographically detected and ≤5 mm (2) mammographically detected, pathologic size 6‐10 mm, age >40 and (3) tubular carcinoma ≤10 mm. All other groups had a >10% risk of nodes and may benefit from axillary dissection. J. Surg. Oncol. 1997;65:34‐39. © 1997 Wiley‐Liss, Inc.</description><subject>Adult</subject><subject>Axilla</subject><subject>axillary lymphadenopathy</subject><subject>Biological and medical sciences</subject><subject>breast conservation surgery</subject><subject>Breast Neoplasms - chemistry</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Carcinoma, Ductal, Breast - chemistry</subject><subject>Carcinoma, Ductal, Breast - pathology</subject><subject>Carcinoma, Ductal, Breast - surgery</subject><subject>Carcinoma, Lobular - chemistry</subject><subject>Carcinoma, Lobular - pathology</subject><subject>Carcinoma, Lobular - surgery</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis</subject><subject>Mammary gland diseases</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Prognosis</subject><subject>prognostic factors</subject><subject>Receptors, Estrogen - metabolism</subject><subject>Risk</subject><subject>Tumors</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kF1v0zAYhS0EGmXwE5B8gdB2kc4fiR13E9IUYHSaaKUWJnHzykneCLM0KXFKt3-PQ6vuAsSVZZ2jx8cPIeecjTlj4uxkMc2mp5wZFRlm0hNujGbJqUom_ELGk8nl9H10vZjpd3LMxtnsXETzJ2R06D8lo0ARUawNe05eeP-DMWaMio_IkeHaCJWMyO20xKZ3lSts79qGthXdtits6Nb13-mSR0tB8w6t72lhmwI7antat1vaOX83tNetd737hdTeu7q23QNt2hL9S_KssrXHV_vzmHz5-GGZfYpuZlfT7PImKmKR6EiZClOpWJJgjKmVaV7mcVKFSKdFzlDb3BaiMjq3slSlRiFNzE0sbVmiTY08Jm933HXX_tyg72HlfIFhSYPtxkP4u1SC8VBc7IpF13rfYQXrzq3CXuAMBt0Ag24Y9MGgD3a6QSXAQcYAQTcMukECg2wGAuaB-nr__CZfYXlg7v2G_M0-t76wddUFh84fakIZoTV7HLd1NT78tez_w_6x6889UKMd1fke7w9U292B0lIncPv5CtQ3cz3_mqag5G9Y77Xz</recordid><startdate>199705</startdate><enddate>199705</enddate><creator>Fein, Douglas A.</creator><creator>Fowble, Barbara L.</creator><creator>Hanlon, Alexandra L.</creator><creator>Hooks, Mary A.</creator><creator>Hoffman, John P.</creator><creator>Sigurdson, Elin R.</creator><creator>Jardines, Lori A.</creator><creator>Eisenberg, Burton L.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley-Liss</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199705</creationdate><title>Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes</title><author>Fein, Douglas A. ; Fowble, Barbara L. ; Hanlon, Alexandra L. ; Hooks, Mary A. ; Hoffman, John P. ; Sigurdson, Elin R. ; Jardines, Lori A. ; Eisenberg, Burton L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4257-69fe836055e4e8a38bdb45f25778cb0e7abac2f97ba3d6d7e23941943addea893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adult</topic><topic>Axilla</topic><topic>axillary lymphadenopathy</topic><topic>Biological and medical sciences</topic><topic>breast conservation surgery</topic><topic>Breast Neoplasms - chemistry</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Carcinoma, Ductal, Breast - chemistry</topic><topic>Carcinoma, Ductal, Breast - pathology</topic><topic>Carcinoma, Ductal, Breast - surgery</topic><topic>Carcinoma, Lobular - chemistry</topic><topic>Carcinoma, Lobular - pathology</topic><topic>Carcinoma, Lobular - surgery</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Lymph Node Excision</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis</topic><topic>Mammary gland diseases</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Prognosis</topic><topic>prognostic factors</topic><topic>Receptors, Estrogen - metabolism</topic><topic>Risk</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fein, Douglas A.</creatorcontrib><creatorcontrib>Fowble, Barbara L.</creatorcontrib><creatorcontrib>Hanlon, Alexandra L.</creatorcontrib><creatorcontrib>Hooks, Mary A.</creatorcontrib><creatorcontrib>Hoffman, John P.</creatorcontrib><creatorcontrib>Sigurdson, Elin R.</creatorcontrib><creatorcontrib>Jardines, Lori A.</creatorcontrib><creatorcontrib>Eisenberg, Burton L.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fein, Douglas A.</au><au>Fowble, Barbara L.</au><au>Hanlon, Alexandra L.</au><au>Hooks, Mary A.</au><au>Hoffman, John P.</au><au>Sigurdson, Elin R.</au><au>Jardines, Lori A.</au><au>Eisenberg, Burton L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes</atitle><jtitle>Journal of surgical oncology</jtitle><addtitle>J. Surg. Oncol</addtitle><date>1997-05</date><risdate>1997</risdate><volume>65</volume><issue>1</issue><spage>34</spage><epage>39</epage><pages>34-39</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><coden>JSONAU</coden><abstract>Background and Objectives: The diagnostic and therapeutic significance of axillary dissection has been questioned. We sought to define a subgroup of patients with early‐stage breast cancer who are at low risk for positive axillary nodes.
Methods
Between 1970 and 1995, 1,598 women with stage I and II breast cancer underwent level I‐II axillary dissection with a minimum of 10 nodes removed. The following factors were examined in univariate analysis for predicting positive nodes: race, method of detection, location of the primary tumor, age, menopausal status, obesity, ER status, PR status, pathologic tumor size, lymphatic vascular invasion, tumor grade, and histology.
Results
Four hundred and forty‐five of the 1,598 patients (27.8%) had histologically positive axillary nodes. Significant factors in univariate analysis for positive nodes included: tumor size, lymphatic vascular invasion, grade, method of detection, primary tumor location, and age. The only group of women with a 0% risk of axillary nodes were those in whom the pathologic tumor size was ≤5 mm and mammographically detected. A 5‐10% risk of positive axillary nodes was identified in women with (1) pathologic tumor size 6‐10 mm, mammographically detected, and age ≤40 years, and (2) tubular carcinoma ≤10 mm. Tumors detected on physical examination with or without mammography and women ≤40 years had a significantly increased risk of nodes. In multivariate analysis lymphatic vascular invasion (P <0.001), method of detection (P = 0.026), location (P = 0.01), and pathologic tumor size (P = 0.002) were significant predictors of positive axillary lymphadenopathy.
Conclusions
The decision to forego an axillary dissection should be considered in (1) tumors mammographically detected and ≤5 mm (2) mammographically detected, pathologic size 6‐10 mm, age >40 and (3) tubular carcinoma ≤10 mm. All other groups had a >10% risk of nodes and may benefit from axillary dissection. J. Surg. Oncol. 1997;65:34‐39. © 1997 Wiley‐Liss, Inc.</abstract><cop>New York</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>9179265</pmid><doi>10.1002/(SICI)1096-9098(199705)65:1<34::AID-JSO7>3.0.CO;2-P</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Axilla axillary lymphadenopathy Biological and medical sciences breast conservation surgery Breast Neoplasms - chemistry Breast Neoplasms - pathology Breast Neoplasms - surgery Carcinoma, Ductal, Breast - chemistry Carcinoma, Ductal, Breast - pathology Carcinoma, Ductal, Breast - surgery Carcinoma, Lobular - chemistry Carcinoma, Lobular - pathology Carcinoma, Lobular - surgery Female Gynecology. Andrology. Obstetrics Humans Lymph Node Excision Lymph Nodes - pathology Lymphatic Metastasis Mammary gland diseases Medical sciences Middle Aged Neoplasm Staging Prognosis prognostic factors Receptors, Estrogen - metabolism Risk Tumors |
| title | Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes |
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