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s – Poster Session I 37 105 The First 2,000 Cases Axillary Node Metastases in the Sentinel Lymph Node Era. Bevilacqua JLB, Tan LK, Borgen PI, Cody III HS, Heerdt AS, Montgomery LL, Petrek JA, Van Zee KJ. Breast Service, Departments of Surgery and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY. The presence of axillary lymph node metastases (ALNM) remains the most important prognostic indicator for a woman with breast carcinoma (ca). The adoption of sentinel lymph node (SLN) biopsy and enhanced pathologic analysis of the SLN marks a new era in the treatment of breast cancer. We undertook this analysis to examine the clinical and pathological predictive factors of ALNM in this new era. METHODS: From 9/1996 to 3/2000, we performed 2,000 consecutive SLN procedures (cases) in 1,819 patients. 1,849 cases had measurable invasive ca. Of these, 1,556 were ductal not otherwise specified (NOS), 103 were special ductal subtypes (mucinous, tubular, or medullary), and 190 were lobular ca. Univariate (T- Test and χ) and multivariate analyses (binary logistic regression) were performed. RESULTS: By T stage (AJCC-1997), the frequency of ALNM was: T1mic= 3/32 (9.4%), T1a= 34/223 (15.2%), T1b= 106/501 (21.2%), T1c= 272/791 (34.4%), T2≤3cm= 126/231 (54.5%), T2>3cm= 40/58 (69%), T3= 13/13 (100%). The p-values for variables significantly associated with ALNM are listed in the table. Variable Univariate Univariate Multivariate Multivariate Ductal Lobular Ductal Lobular Age NS Size Palpability NS Lymphovascular Invasion (LVI) Histologic Grade NS NA Nuclear Grade 0.036 NA Ductal NOS vs. Special Subtype 0.001 NA UIQ vs. Other Quadrant Multifocality 0.001 0.001 0.027 Table Notes: NA=not applicable, NS=non-significant. CONCLUSIONS: Tumor size, LVI, age, nuclear grade, histologic subtype, multifocality, and location in the breast were independent predictive factors for ALNM for ductal ca. For upper-inner quadrant (UIQ) ductal ca, ALNM were less frequent than for other quadrant tumors. Only tumor size and multifocality were independent predictive factors for ALNM in lobular ca. 106 RT-PCR Analysis for Mammaglobin and Carcinoembryonic Antigen Detects Metastases in Histology-Negative Sentinel Lymph Nodes. Verbanac KM, Min CJ, Purser SM, Swanson MS, Lo K, Albrecht JA, Tafra L. Surgery, East Carolina University, Greenville, NC; National Genetics Institute, Los Angeles, CA; 3Anne Arundel Medical Center, Annapolis, MD. Axillary staging is critical for predicting breast cancer recurrence and for guiding treatment, yet lymph node (LN) metastases are missed in many patients by current methods. To improve staging accuracy, we have combined sentinel lymphadenectomy with the sensitive technique of reverse transcriptase-polymerase chain reaction (RT- PCR). As the first investigators to identify mammaglobin (MG) and carcinoembryonic antigen (CEA) as specific dual markers for the RT-PCR detection of SLN metastases, our objective was to determine if this molecular analysis does in fact detect occult metastases. Here we present analysis of 154 SLN from 87 patients enrolled in a multi-center trial: 37% node-positive by histology (Histo+ = H&E ± IHC) and 63% node-negative. As single markers, PCR for MG and CEA identified 94% and 84% of patients with Histo+ LN. Only one patient with histologically involved LN failed to express either marker (3% false negative rate) and 78% had LN that expressed both markers. Each marker increased the detection of metastases in Histopatients (n = 55): MG+ CEA+ MG+ CEA+ MG+ or CEA+ MGCEA- 15 pts (27%) 14 pts (25%) 5 pts (9%) 24 pts (44%) 31 pts (56%) Thus, PCR detection of MG or CEA in SLN would upstage 44% of Histowomen, consistent with clinical recurrence rates. Marker expression correlates with tumor size and estrogen receptor negativity. Clinical recurrence wil l determine the significance of molecular staging: no node-negative women have recurred to date (mean follow-up 31 months). These results show that MG and CEA remain promising dual clinical markers for RT-PCR detection of SLN micrometastases for improved staging and management of breast cancer patients. 107 Variations of Success Rates for Sentinel Node Mapping in Breast Cancer: Results of a German Multicenter Study. Kuehn T, Kotzerke J, Santjohanser C, Schirrmeister H, Grimm S, Koretz K, Rebstock AB, Reske SN, Kreienberg R. University Medical Center of Ulm, Germany. Objective: Promising results have been reported for sentinel node mapping in breast cancer and numerous institutions have already abandoned routine axillary dissection for small breast cancers. The success rates reported in literature, however, vary and many questions concerning the technical proceeding are still not standardized. In order to analyze whether sentinel node biopsy was a reliable procedure, we performed a multicenter validation study and evaluated the detection rate and the sensitivity of each participating center as well as the results of different surgeons. Material and Methods: The data of 709 patients were prospectively collected. Only patients with unicentric disease and clinically negative axillary status were included. All patients received full axillary dissection after sentinel node biopsy had been performed. The surgeon was free to chose the lymphography, as well as the injection technique. Results: 16 centers participated in the trial and performed 709 sentinel node biopsies. The blue dye technique was used in 139 patients, lymphoscintigraphy in 127 and a combined procedure in 442 cases. The overall detection rate was 84.3% and the sensitivity 91.3%. An interinstitutional variation of success rates for sentinel node identification was found between 57.1% (Tc only and combined) and 94.1% (Tc only), the false negative rate varied between 22.2% (Tc only and combined) and 0% (all techniques). The center with the lowest detection rate had also the highest rate of false negative findings. When the data of all surgeons with less than 10 procedures were summarized, an overall detection rate of 75.4% and a sensitivity of 91.4% was found. For surgeons with more than 20 procedures the detection rate varied between 71.4% and 100% and the sensitivity between 71.4% and 100%. Conclusion: Sentinel node mapping seems a promising tool for axillary management in breast cancer. Success rates, however, vary strongly between different institutions and surgeons. In order to obtain reliable results for the procedure, a standardized and detailed protocol for the technical proceeding is necessary, as well a defined training program. 108 A New Score for the Assessment of Postsurgery Morbidity Following Axillary Surgery. Kuehn T, Klauss W, Darsow M, Regele S, Flock F, Wendt I, Rebstock AB, Kreienberg R. University Medical Center of Ulm, Germany. Introduction: One endpoint of numerous trials is the assessment of arm symptoms following new techniques of axillary surgery. Shoulder arm morbidity, however, is a complicated polysymptomatic disease and diverging techniques are currently used to assess subjective and objective symptoms. In order to optimize the assessment of this complex syndrome, we developed a specific score that summarizes the occurrence as well as the intensity of subjective and objective symptoms. Material and Methods: 396 patients who had undergone conventional axillary surgery were thoroughly examined for postsurgical morbidity. Objective and subjective symptom occurrence and symptom intensity were evaluated using 5-point scales. Reproducible techniques were applied for clinical evaluation. According to their significance and their degree of intensity, different symptoms were summarized on a scale where subjectively and objectively assessed symptoms were each given 50% consideration. A maximum of 5 pts was assigned if no sensitivity problem was registered, 25 pts for absence of pain and 20 pts for unimpaired strength, mobility and edema respectively. According to the intensity of symptoms within the 5-point scales, score points were subtracted. A patient with 100 score points was regarded as completely free of disease. Results: When all clinical measurements and the results from a 5-point-scaled questionnaire were summarized in a specific score, only 12 patients achieved 100 score points. 82 patients had > 90 pts, 80 women achieved between 80 and 90 pts, 73 between 70 and 80 pts, 73 between 60 and 70 pts, 34 between 50 and 60 pts and 27 had surgeons a variation of the median between 70.8 and 82.3 was registered Discussion: Shoulder arm morbidity following axillary surgery is a polysymptomatic disease that can bes t be expressed on a score that summarizes the occurrence as well as the intensity of several symptoms. The use of a specific score facilitates the assessment of postsurgical outcome so that the comparability of clinical trials may be improved. The effect of rehabilitation measures can equally be verified. Breast Cancer Research and Treatment Vol. 64, No. 1, November (1) 2000

Modelos estatísticos para previsão de metástases axilares em câncer de mama em pacientes submetidos à biópsia de linfonodo sentinela