Breast cancer larger than 2.5 cm with tumor-free radioisotope-hot sentinel nodes has higher risk of non-hot axillary lymph node metastasis.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is the standard axillary staging approach for early breast cancer with clinically negative axillary involvement. Adequate SLNB should include the removal of not only radioactive tracer-labeled lymph nodes (hot nodes or SLNs) but also suspicious unlabeled nodes (non-hot nodes or non-SLNs). However, the biopsy of non-hot nodes is highly dependent on the surgeons' experiences. This article aims to facilitate the surgeon's decision making by elucidating parameters that correlate with non-hot node metastasis. METHODS: From 2013 to 2016, clinically node-negative (cN0) breast cancer patients receiving axillary SLNB using single Tc-99m tracer method at our institute were recruited. Patients were excluded if they had received prior neoadjuvant chemotherapy. Among them, cases that have at least one non-isotope-hot node biopsied were retrospectively reviewed with a particular focus on patients with pathologically negative isotope-hot SLNs. The correlation of clinicopathological data with metastasis to axillary lymph nodes and sentinel lymph nodes was analyzed with the Chi-squared test, Fisher's exact test, and multivariate logistic regression. Receiver operating curve (ROC) was applied for continuous variables that predicted non-hot node metastasis; relapse-free survival (RFS) and locoregional relapse-free survival (LRRFS) were compared by Kaplan-Meier analysis. RESULTS: In 632 isotope-hot SLN negative patients, T stage showed a correlation with non-isotope-hot SLN metastasis (p = 0.035, odds ratio (OR) 9.65). Tumors larger than 2.5 cm best predict non-isotope-hot SLN metastasis (area under curve (AUC) = 0.71). With a median follow up of 41.80 months, locoregional relapse-free survival was significantly worse in cases with non-hot node metastasis (66.2% vs. 69.0%, p = 0.001). CONCLUSION: In the setting of SLNB using single radioisotope tracer, non-hot node metastasis in cases with negative hot SLN still carries a higher locoregional recurrence rate (13.3%). For early breast cancer larger than 2.5 cm, removal of suspicious non-hot nodes should be included for a precision therapy.

Low body mass index is an independent risk factor of locoregional recurrence in women with breast cancer undergoing breast conserving therapy.

BACKGROUND: To investigate the risk factors and prognosis for locoregional recurrence (LRR) after breast conserving treatment (BCT) in women with early breast cancer. METHODS: Women who had undergone BCT from 1998 to 2005 at Chang Gung Memorial Hospital were retrospectively reviewed. LRR was defined as the reappearance of invasive carcinoma in the treated breast and/or ipsilateral axillary lymph node (ALN). The appearance of carcinoma outside this area was defined as distant metastasis (DM). Patient characteristics, tumor characteristics, treatment modality, and follow-up clinical evaluations were analyzed. Survival was estimated by the Kaplan-Meier method and compared with the log-rank test. A multivariate model was built by the Cox regression method. RESULTS: This study included 858 patients, and the median follow up time was 36 (range 6-193) months. Twenty seven patients developed LRR for a crude LRR rate of 3.1%. The 5-year cumulative incidence of LRR was 5.0%. The mean age of patients at the primary operation was 45 (+/-9.8) years old. Their median body mass index (BMI) was 23 (range 16-40) kg/m(2). Univariate analysis of locoregional recurrence free survival (LRRFS) revealed that age < or =40 years, a low BMI (< or =24 kg/m(2)) and omission of postoperation radiotherapy were unfavorable factors. Low BMI and young age were independent prognostic factors for LRRFS in multivariate analysis. The five-year overall survival of patients with no recurrence, LRR and DM were 97.4%, 63.2% and 41.6%, respectively (p < 0.001). CONCLUSIONS: BCT in a young population can result in good locoregional control after careful preoperative evaluation. Women with a low BMI are at high risk of LRR.