Relevant impact of central pathology review on nodal classification in individual breast cancer patients

J. H. M. J. Vestjens, M. J. Pepels, Maaike de Boer, George F. Borm, Carolien H. M. van Deurzen, Paul J. van Diest, J. A. A. M. van Dijck, E. M. M. Adang, J.W.R. Nortier, Emiel J. Th Rutgers, C. Seynaeve, Marian B. E. Menke-Pluymers, P. Bult, V. C. G. Tjan-Heijnen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


In the MIRROR study, pN0(i + ) and pN1mi were associated with reduced 5-year disease-free survival (DFS) compared with pN0. Nodal status (N-status) was assessed after central pathology review and restaging according to the sixth AJCC classification. We addressed the impact of pathology review. Early favorable primary breast cancer patients, classified pN0, pN0(i + ), or pN1(mi) by local pathologists after sentinel node procedure, were included. We assessed the impact of pathology review on N-status (n = 2842) and 5-year DFS for those without adjuvant therapy (n = 1712). In all, 22% of the 1082 original pN0 patients was upstaged. Of the 623 original pN0(i + ) patients, 1% was downstaged, 26% was upstaged. Of 1137 patients staged pN1mi, 15% was downstaged, 11% upstaged. Originally, 5-year DFS was 85% for pN0, 74% for pN0(i + ), and 73% for pN1mi; HR 1.70 [95% confidence interval (CI) 1.27-2.27] and HR 1.57 (95% CI 1.16-2.13), respectively, compared with pN0. By review staging, 5-year DFS was 86% for pN0, 77% for pN0(i + ), 77% for pN1mi, and 74% for pN1 + . Pathology review changed the N-classification in 24%, mainly upstaging, with potentially clinical relevance for individual patients. The association of isolated tumor cells and micrometastases with outcome remained unchanged. Quality control should include nodal breast cancer staging.
Original languageEnglish
Pages (from-to)2561-2566
JournalAnnals of Oncology
Issue number10
Publication statusPublished - Oct 2012


  • breast cancer
  • pathology review
  • sentinel node

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