Measurement of extracapsular extension in sentinel lymph node as a possible predictor of residual axillary disease in breast cancer

Freitas, Gabriela Boufelli de; Mota, Bruna Salani; Maesaka, Jonathan Yugo; Pinheiro, Cintia Cardoso; Lima, Luiz Guilherme Cernaglia Aureliano de; Soares Jr., José Maria; Baracat, Edmund Chada; Filassi, José Roberto

doi:10.1016/j.clinsp.2023.100216

Brasil

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100216 linkcopy

Measurement of extracapsular extension in sentinel lymph node as a possible predictor of residual axillary disease in breast cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

This study aimed to find the clinical significance of the extracapsular extension in sentinel lymph nodes on the number of additional involved axillary lymph nodes, overall survival, and disease-free survival.
One hundred twenty-eight patients with positive sentinel lymph nodes were separated into two groups according to the presence or absence of ECE and following during 10 years.
There was found a positive correlation between the presence of ECE and the number of additional positive lymph nodes. Therefore, this does not impact overall survival, and disease-free survival in a follow-up of 10 years.

Abstract

Background The presence of Extracapsular Extension (ECE) in the Sentinel Lymph Node Biopsy (SLNB) is still a doubt in the literature. Some studies suggest that the presence of ECE may be related to a greater number of positive axillary lymph nodes which could impact Disease Free Survival (DFS) and Overall Survival (OS). This study searches for the clinical significance of the ECE.

Methods Retrospective cohort comparing the presence or absence of ECE in T1-2 invasive breast cancer with positive SLNB. All cases treated surgically at the Cancer Institute of the State of São Paulo (ICESP) between 2009 and 2013 were analyzed. All patients with axillary disease in SLNB underwent AD.

Outcomes Identify the association between the presence and length of ECE and additional axillary positive lymph nodes, OS and DFS between both groups.

Results 128 patients with positive SLNB were included, and 65 had ECE. The mean metastasis size of 0.62 (SD = 0.59) mm at SLNB was related to the presence of ECE (p < 0.008). The presence of ECE was related to a higher mean of positive sentinel lymph nodes, 3.9 (± 4.8) vs. 2.0 (± 2.1), p = 0.001. The median length of follow-up was 115 months. The OS and DFS rates had no differences between the groups.

Conclusion The presence of ECE was associated with additional positive axillary lymph nodes in this study. Therefore, the OS and DFS were similar in both groups after 10 years of follow-up. It is necessary for additional studies to define the importance of AD when SLNB with ECE.

Keywords Breast Neoplasms; Biopsy, Sentinel Lymph Node; Lymphatic metastasis

			ECE		Total	p
			Absence	Presence	Total	p
Age (mean)			57,9	57,4		0.33
Lymphovascular invasion	Absence	n (%)	43 (33.86)	37 (29.13)	81 (62.99)	0.15
Lymphovascular invasion	Presence	n (%)	19 (14.96)	28 (22.05)	47 (37.01)	0.15
Nuclear grade	1	n (%)	1 (0.78)	4 (3.12)	5 (3.91)	0.334
	2	n (%)	33 (25.78)	29 (22.66)	62(48.44)
	3	n (%)	29 (22.66)	32 (25.00)	61 (47.66)
Histologic grade	1	n (%)	13 (10.16)	13 (10.16)	26 (20.31)	0.89
	2	n (%)	34 (25.56)	30 (23.44)	64 (50.00)
	3	n (%)	16 (12.50)	22 (17.19)	38 (29.69)
Pt ‒ TNM	T1	n (%)	31 (24.22)	20 (15.62)	51 (39.84)	0.03
Pt ‒ TNM	T2	n (%)	32 (25.00)	45 (35.16)	77 (60.16)	0.03
Pn ‒ TNM	N0 (i+)	n (%)	2(1.56)	0 (0.0)	2(1.56)	0.02
	N1	n (%)	53 (41.41)	43 (33.59)	96 (75.0)
	N2	n (%)	7 (5.47)	18 (14.06)	25 (19.53)
	N3	n (%)	1 (0.78)	4 (3.12)	5 (3.91)
Histologic type	Idc	n (%)	58 (45.31)	60 (48.88)	118 (92.19)	0.79
	Ilc	n (%)	3 (2.34)	4 (3.12)	7 (5.47)
	Other	n (%)	2 (1.56)	1 (0.78)	3 (2.34)
Molecular subtype	Luminal A	n (%)	30 (23.44)	29 (22.66)	59 (46.09)	0.76
	Luminal B	n (%)	20 (15.62)	26 (20.31)	46 (35.94)
	Rh-/her2-	n (%)	5 (3.91)	4 (3.12)	9 (7.03)
	Rh+/her2+	n (%)	5 (3.91)	5 (3.91)	10 (7.81)
	Rh-/her2+	n (%)	3 (2.34)	1 (0.78)	4 (3.12)

	ECE	n	Mean (Standard Deviation)	p
Metastasis size in the SLN (cm)	Absence	63	0.3676 (0.32)	0.008
Metastasis size in the SLN (cm)	Presence	65	0.6248 (0.59)
Number of positive LND	Absence	63	2.000 (2.063)	0.001
Number of positive LND	Presence	65	3.877 (4.784)
t-test

ECE	n	Events (deaths)	Overall survival
ECE	n	Events (deaths)	n	%
Absence	63	9	54	85.7%
Presence	65	10	55	84.6%
Total	128	19	109	85.2%
Follow-up 115 months

ECE	n	Local recurrence	Visceral recurrence	Disease-free survival
ECE	n	Local recurrence	Visceral recurrence	n	%
Absence	63	3	9	51	81.0%
Presence	65	1	15	49	75.4%
Total	128	4	24	100	78.1%
Follow up 115 months

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