Abstract
Perpose
Breast cancer is the most common cancer among women in France. Axillary lymph node invasion has a major prognostic impact. The aim of this study was to evaluate the risk and predictive factors of the rate of lymph node invasion in breast cancer with axillary involvement.
Methods
A retrospective study was conducted at the Lorraine Cancer Institute between 1 January 2014 and 31 December 2015. It included patients with breast cancer who underwent breast surgery associated with ALND (either immediately in case of positive FNAC, or secondarily in case of positive SLNB).
Results
In total, 194 patients were included. 99 underwent SLNB and ALND after (Group 1), 95 had a positive node in the FNAC and underwent ALND (Group 2). Multivariate analysis shown that only age at diagnosis (RR 2.79 [1.27; 5.74]), ultrasound tumor size (RR 2.97 [1.20; 7.64]), LVSI (RR 1.88 [1.07; 2.74]), multifocality (RR 2.27[1.35; 5.41]) and high histological grade (RR 3.38 [1.45; 9.74]) were significantly associated with a high axillary involvement. There was a 1.28% recurrence rate at 5 years in Group 1, compared with 28.21% recurrence rate at 5 years in Group 2 (p<0.001).
Conclusions
Age, tumor size (on ultrasound), lymphovascular invasion, multifocality and histological grade are risk and predictors factors of the rate of lymph node invasion. Preoperative positive FNB have a greater degree of lymph node involvement and a worse overall and progression-free survival than patients whose lymph node involvement was discovered at the time of the SLNB.