Different outcome in node-positive breast cancer patients found by axillary ultrasound or sentinel node procedure

Nicole C. Verheuvel*, Adri C. Voogd, Vivianne C. G. Tjan-Heijnen, S. Siesling, Rudi M. H. Roumen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Web of Science)

Abstract

The Z0011 trial initiated a paradigm shift in the axillary treatment of breast cancer patients with a positive sentinel lymph node biopsy (SLNB), disregarding patients with a positive ultrasound-guided lymph node biopsy (UGLNB). We examined whether relevant differences exist between these patients to determine if the conclusions of the ACOSOG Z0011 trial are applicable to UGLNB-positive patients.

Patients diagnosed with invasive breast cancer in the Netherlands between January 2008 and December 2014 were selected from the Netherlands Cancer Registry.

A total of 11,820 cases were included: 9149 cases in the SLNB group and 2671 in the UGLNB group. Multivariate analyses showed that UGLNB-positive patients were older (p <0.001), more likely to have a poorly differentiated tumor (p <0.001), had a negative hormone receptor status (p <0.001), and more often had extensive nodal involvement (p <0.001). However, they were less likely to undergo adjuvant radiation (p = 0.004) or systemic therapy (p <0.001). Even after adjusting for these factors, UGLNB-positive patients had a worse overall survival (HR = 1.38; 95% CI 1.23-1.56) than SLNB-positive patients.

This nationwide retrospective study shows that young patients found positive by UGLNB have less favorable disease characteristics and a worse prognosis compared to patients with a positive SLNB. Selection by ultrasound plays an important role when axillary treatment strategies are considered. Hence, the conclusions of the Z0011 trial cannot unconditionally be applied to patients with a positive UGLNB.

Original languageEnglish
Pages (from-to)555-563
Number of pages9
JournalBreast Cancer Research and Treatment
Volume165
Issue number3
DOIs
Publication statusPublished - Oct 2017

Keywords

  • Ultrasound
  • Sentinel node
  • Breast cancer
  • Survival
  • ACOSOG Z0011 TRIAL
  • AMERICAN-COLLEGE
  • CLINICAL-PRACTICE
  • LYMPH-NODES
  • SURGEONS
  • DISSECTION
  • METASTASES
  • BIOPSY
  • IMPACT
  • INVOLVEMENT

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