Axillary node metastases in relation to size and location of breast cancers: analysis of 147 patients

This prospective study of 147 patients undergoing axillary lymphadenectomy for treatment of breast cancer over a 3 1/2-year period relates frequency and number of involved lymph nodes to the size and location of the tumor within the breast. A total of 35.3 per cent of patients in the entire series had axillary metastases. Of 29 patients with cancers 0-10 mm, five had axillary metastases (17.2%). All five cancers were located at the upper outer quadrant (UOQ) of the breast. Thirteen of 58 patients with cancers 11-20 mm had positive nodes. Eight of the 13 cancers were at the UOQ. Only one of 13 patients with cancer at the lower inner quadrant had nodal metastases. A total of 25.8 per cent of cancers 0-20 mm located at the upper half of the breast were associated with positive nodes, in contrast with 11.1 per cent of those located in the center and 7.1 per cent of those located in the lower half of the breast; likewise, 28 per cent of cancers 0-20 mm located at the lateral aspect of the breast had axillary nodes involved, and 11.5 per cent when cancer was located in the median half. Using such an analysis, 25 per cent of all lymphadenectomies could have been omitted, as could 37.9 per cent of those performed for T1 cancers (0-20 mm) without compromising systemic adjuvant therapy.