Lymph node metastasis in breast carcinoma: clinicopathological correlations in 3747 patients

Histological axillary node involvement (ANI) evaluated by axillary dissection remains the most accurate predictive factor for patients with invasive breast cancer. Axillary node involvement implies the necessity of systemic adjuvant treatment and locoregional irradiation.

Is to detect the relative frequency of node positivity in relation to histopathology through studying a large mastectomy series.

This study included 3747 mastectomy specimens performed at NCI, Cairo in the period 1993-2003. In each case we assessed the age at time of diagnosis, pathologic tumor size and number, histologic subtype (including grade), tumor location, number of lymph nodes dissected and number of positive nodes (burden of node positivity).

Females constituted 96.8% of cases, 60.7% of them were premenopausal. The mean age was 47.1% +/- 10.5 years. Tumor size ranged from 0.5 to 20 cm. The global ANI rate in the entire cohort was 70.6%. In univariate analysis, five variables were significantly correlated to ANI, these were laterality, multiplicity, tumor size, histologic subtype and grade, while multiplicity, tumor size, histologic subtype and grade correlated significantly with metastatic burden. Multivariate analysis showed that older women (40-60 and > 60 years) have at least half the risk of developing LN metastasis compared to those < 40 years with the odds of 0.51 (0.35-0.73) and 0.31 (0.18-0.55), respectively. Tumor size > 2 cm put the women with breast cancer at 3 (if 2-5 cm) to 9 (if > 5 cm)folds of developing lymph node (LN) metastasis. Tumor size > 5 cm increases the likelihood of higher metastatic burden (> 3 +ve nodes) with odds of 1.5 (1.24-1.9). Unfavourable histology also increases the likelihood of more positive nodes to the double when compared to favourable histology.

The results of this study reflected the unfortunate presentation of breast cancer patients. In addition, some factors could be used as useful guidelines in the management of those patients. These factors include age, tumor size and histologic type of the tumor.