Clinical Features of Breast Cancer without Axillary Lymph Node Metastasis

ABSTRACT

PURPOSE: Axillary dissection has, for many years, maintained its role as the primacy surgical therapy for invasive breast carcinomas for many years. However, with the advent of screening mammography, more breast cancers are detected at an earlier stage and are apparently confined to the breast without nodal involvement. Therefore, axillary node dissection may no longer be considered to be the standard treatment for all patients with invasive breast cancer. METHODS: We reviewed the case histories of 404 patients with breast cancer who had been treated at the Department of Surgery, Samsung Medical Center between Jan 1997 and Dec 1998. Two-hundred two of those patients had negative nodal involvement. Clinical and pathological results were compared between node negative and node positive cases and the results were analyzed by using the chi-square test. RESULTS: The peak age of the patients was in the forties but premenopausal patients were more frequent in node negative patients than in nodal involvement patients. More node negative patients than node-positive patients had tumor mass less than 2 cm in size in node-negative patients invasive carcinomas were less frequent than in node-positive patients, but and special type with good prognostic histology and intraductal carcinomas were found more frequently. Lymphatic or vascular invasions were less frequent (4.5%) in the node negative group than in the node positive group (33.5%). Tumors located in the upper outer quadrant were less frequent in node negative cases than in node positive cases. Breast conservation surgery was performed more frequently in node negative cases than in node positive cases. Symptoms and signs, mammographic findings, hormonal receptor status and C-erbB2 & p53 were not associated with nodal status. In node negative patients, the estrogen receptor status and the histologic or nuclear grade were linearly correlated in this study. CONCLUSION: Compared to node positive breast cancer, age, tumor size, histologic type, and lymphovascular invasion were different in node negative malignancies. The characteristics of the primary tumor can be helpful to assess the risk for axillary node metastasis.