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More tumor‐affected lymph nodes because of the sentinel lymph node procedure but no stage migration, because the 2002 TNM classifies small tumor deposits as pathologic N0 breast cancer
Author(s) -
Bolster Marieke J.,
Bult Peter,
Wauters Carla A. P.,
Strobbe Luc J. A.,
Peer Petronella G. M.,
Wobbes Theo,
TjanHeijnen Vivianne C. G.
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24629
Subject(s) - medicine , lymph , stage (stratigraphy) , lymph node , breast cancer , sentinel lymph node , primary tumor , cancer , radiology , oncology , metastasis , surgery , pathology , paleontology , biology
BACKGROUND: Intensified examination of the sentinel lymph node (SN) may result in increased detection of tumor‐affected lymph nodes. The authors of this report hypothesized that the introduction of the SN procedure has led to stage migration because of the intensified workup of SNs by pathologists. METHODS: After the introduction of the SN procedure, 360 patients with operable breast cancer were included prospectively from 2 large hospitals (Hospital A and Hospital B). The prospectively included patients (the “SN era” group) were compared with 88 historic controls from the year 1994 who were diagnosed with primary breast cancer before introduction of the SN procedure. RESULTS: After correcting for classic clinical and pathologic prognostic factors in a multiple logistic regression analysis, the detection frequency of lymph node involvement was significantly higher in the SN era group compared with historic controls ( P = .04). However, when using the 2002 TNM classification, in which isolated tumor cells (≤0.2 mm) were categorized as lymph node‐negative disease, no stage migration was observed ( P = .98). Also, when analyzing both hospitals (Hospital A vs Hospital B) separately with respect to lymph node involvement, there was no difference, between the SN era and the historic controls ( P = .79 and P = .69, respectively). This remained nonsignificant after the analysis was corrected for patient and primary tumor characteristics ( P = .85 and P = .66, respectively). CONCLUSIONS: Introduction of the SN procedure has led to the detection of more tumor‐affected lymph nodes because of the intensified workup of SNs by pathologists. However, stage migration did not occur when tumor deposits of ≤0.2 mm were categorized as lymph node‐negative disease, according to the 2002 TNM classification. Cancer 2009. © 2009 American Cancer Society.