Correlation between sentinel lymph node biopsy and non-sentinel lymph node metastasis in patients with cN0 breast carcinoma: comparison of invasive ductal carcinoma and invasive lobular carcinoma

Calogero Cipolla ^1,2, Simona Lupo ², Nello Grassi ¹

⁰Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy.

World Journal of Surgical Oncology +

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April 16, 2024

View abstract on PubMed

Summary

Invasive lobular carcinoma (ILC) patients with positive sentinel lymph nodes have a higher risk of non-sentinel lymph node metastasis compared to invasive ductal carcinoma (IDC). Further research is needed before omitting axillary lymph node dissection in ILC cases.

Area Of Science

Oncology
Surgical Pathology
Breast Cancer Research

Background

Axillary lymph node dissection (ALND) avoidance is debated for cN0 breast cancer with 1-2 positive sentinel lymph nodes (SLNs).
Limited data exist for invasive lobular carcinoma (ILC) patients, making ALND omission controversial.
This study investigates metastasis patterns in ILC versus invasive ductal carcinoma (IDC).

Purpose Of The Study

To compare the frequency of non-sentinel lymph node (non-SLN) metastases between ILC and IDC.
To identify factors influencing non-SLN metastasis in breast cancer subtypes.
To inform clinical decisions regarding ALND in ILC patients.

Main Methods

Retrospective analysis of 2583 breast cancer patients (2012-2023).
Comparison of SLN and non-SLN metastasis rates between ILC (341 patients) and IDC (2242 patients).
Multivariate analysis to determine predictors of non-SLN metastasis.

Main Results

SLN metastasis rates were similar: 24.8% for ILC and 22.8% for IDC.
Non-SLN metastasis was significantly higher in ILC (66.7%) compared to IDC (45%) (p=0.02).
ILC was identified as the strongest predictor of non-SLN metastasis.

Conclusions

ILC patients with positive SLNs exhibit a higher incidence of non-SLN metastasis than IDC patients.
ILC status is crucial for predicting non-SLN positivity in cases with SLN macrometastasis.
Omitting ALND in ILC patients with 1-2 positive SLNs requires further investigation.

Keywords:

Axillary lymphadenectomy Breast carcinoma Infiltrating ductal carcinoma Infiltrating lobular carcinoma Non-sentinel lymph node metastasis Sentinel lymph node biopsy