Capsular rupture and axillary lymph node micrometastasis in breast cancer: Therapeutic and prognostic implications

Capsular effraction in breast cancer with axillary lymph node metastasis is associated with higher non-sentinel lymph node metastasis when performing axillary dissection and worse outcome. Despite this, the presence of axillary micrometastasis no longer mandates additional axillary dissection due to their better prognosis. This study examines capsular effraction's specific impact in micrometastatic sentinel lymph nodes on non-sentinel lymph node involvement risk and overall prognosis.

A retrospective study was conducted in the Comprehensive Cancer Center Léon Bérard (Lyon, France), encompassing patients who underwent surgery between January 2005 and December 2015. The study evaluated the involvement of non-sentinel lymph nodes and examined overall survival, progression-free survival, and distant metastasis-free survival in groups with and without capsular rupture using univariable and multivariable Cox regression analyses.

Among 146 patients, 101 (69.2%) had micrometastases without capsular rupture (RC- group), while 45 (30.8%) had micrometastases with capsular rupture (RC+ group). Among patients with lymph node involvement during axillary dissection, a higher proportion had≥2 involved micrometastasis nodes in the RC+ group (33.3%) compared to the RC- group (15.38%) but none had macrometastasis. However, no significant differences were found in overall survival, progression-free survival, or distant metastasis-free survival between the two groups.

Capsular rupture in micrometastatic sentinel lymph nodes is associated with the presence of micrometastatic non-sentinel lymph node involvement but does not seem to impact overall survival and recurrence. Further studies are needed to explore the possible implications of capsular rupture in micrometastasis.