Lymph Node Metastasis and Its Diagnostic Implications Among Women Possessing Ductal Carcinoma of the Breast

Abstract

Abstract Background: Lymph node metastasis is a significant prognostic marker in breast cancer treatment and it is associated with poor prognosis. Periodic acid Schiff’s reagent positive complex in metastatic lymph nodes is an indicator of poor prognosis. The metastatic lymph node variables were evaluated including periodic acid–Schiff (PAS) stain and its significance in prognosis and their association was analyzed concerning clinical and microscopic parameters. Objective: The objective of this study is to determine the lymph node metastasis variables, including its size, number of lymph nodes involved, and other associated pathologies. The clinical and microscopic parameters, including immunohistochemistry (IHC) of the tumor, were studied, and their association with lymph nodes was analyzed. Materials and Methods: In this study, the patients who were diagnosed with ductal carcinoma breast along with lymph node metastasis from 2008 to 2022 were included. The metastatic lymph node size, number, and other associated pathologies were evaluated and PAS stain where ever possible applied, and the results were compared concerning patient age, menopause status, tumor size, grade, invasion, necrosis, calcification, and prognosis (Nottingham prognostic index). IHC for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 /neu status along with vimentin and p53 was also applied and compared. Results: The results revealed that the maximum number of patients below 50 years of age was 54 (58.6%), and belonging to the premenopausal group was 50 (54.3%). The common tumor size among these patients was 5 cm, and below 5 cm was 64 (69.5%). The frequent histological grade was grade II 67 (72.8%), similarly, the favorable prognosis was moderate 55 (59.7%). The largest size of lymph nodes retrieved was 4 cm, the maximum number of lymph nodes involved was 17/19, and >3 metastatic lymph nodes were in 54.34% of cases. The other pathologies, which were found in lymph nodes included granulomatous lesion 2 (2.17%), microfilaria 2 (2.17%), and calcification 4 (4.34%). Immunohistochemistry (IHC) results in tumors having positive nodes were ER (16.30%), PR (11.95%), HER2/neu (21.73%), vimentin (16.30%), and p53 (6.52%). On PAS staining, loops and arches were frequently appreciated. Conclusion: This study concludes that metastatic lymph node is a potential predictor of poor prognosis. It synchronizes with other poor prognostic markers, such as younger age, larger tumor size, grade, invasion, and IHC markers, such as HER2/neu, vimentin, and p53. Other than that, PAS being a cheap and easily available stain, it must applied in metastatic lymph nodes for the determination of prognosis. These factors may be used for better management of breast cancer patients.