Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients

Goshi Oda; Tsuyoshi Nakagawa; Hiroki Mori; Iichiro Onishi; Tomoyuki Fujioka; Mio Mori; Kazunori Kubota; Ryoichi Hanazawa; Akihiro Hirakawa; Toshiaki Ishikawa; Kentaro Okamoto; Hiroyuki Uetakesszsz

doi:10.5306/wjco.v13.i9.748

Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients

World J Clin Oncol. 2022 Sep 24;13(9):748-757. doi: 10.5306/wjco.v13.i9.748.

Authors

Affiliations

¹ Department of Breast Surgery, Tokyo Medical and Dental University, Tokyo 1138519, Japan. odasrg2@tmd.ac.jp.
² Department of Breast Surgery, Tokyo Medical and Dental University, Tokyo 1138519, Japan.
³ Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo 1138519, Japan.
⁴ Department of Pathology, Tokyo Medical and Dental University, Tokyo 1138519, Japan.
⁵ Department of Radiology, Tokyo Medical and Dental University, Tokyo 1138519, Japan.
⁶ Department of Clinical Biostatistics, Tokyo Medical and Dental University, Tokyo 1138519, Japan.
⁷ Department of Specialized Surgeries, Tokyo Medical and Dental University, Tokyo 1138519, Japan.

Abstract

Background: With sentinel node metastasis in breast cancer (BC) patients, axillary lymph node (ALN) dissection is often omitted from cases with breast-conserving surgery. Omission of lymph node dissection reduces the invasiveness of surgery to the patient, but it also obscures the number of metastases to non-sentinel nodes. The possibility of finding ≥ 4 lymph nodes (pN2a/pN3a) preoperatively is important given the ramifications for postoperative treatment.

Aim: To search for clinicopathological factors that predicts upstaging from N0 to pN2a/pN3a.

Methods: Patients who were sentinel lymph node (SLN)-positive and underwent ALN dissection between September 2007 and August 2018 were selected by retrospective chart review. All patients had BC diagnosed preoperatively as N0 with axillary evaluation by fluorodeoxyglucose (FDG) positron emission tomography/computed tomography and ultrasound (US) examination. When suspicious FDG accumulation was found in ALN, the presence of metastasis was reevaluated by second US. We examined predictors of upstaging from N0 to pN2a/pN3a.

Results: Among 135 patients, we identified 1-3 ALNs (pN1) in 113 patients and ³4 ALNs (pN2a/pN3a) in 22 patients. Multivariate analysis identified the total number of SLN metastasis, the maximal diameter of metastasis in the SLN (SLNDmax), and FDG accumulation of ALN as predictors of upstaging to pN2a/pN3a.

Conclusion: We identified factors involved in upstaging from N0 to pN2a/pN3a. The SLNDmax and number of SLN metastasis are predictors of ≥ 4 ALNs (pN2a/pN3a) and predictors of metastasis to non-sentinel nodes, which have been reported in the past. Attention should be given to axillary accumulations of FDG, even when faint.

Keywords: Axillary lymph node metastasis; Breast cancer; Diameter of sentinel lyphonode metastasis; Positron emission tomography/computed tomography; Predictive factors of lymphnode metastasis; Sentinel lymph node; Standardized uptake value max.