Tumour Characteristics Predicting Axillary Nodal Metastasis in Early Breast Cancers- A Study from Southern India XC07-XC11
Dr. Suhaildeen Kajamohideen,
Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Chennai-600116, Tamil Nadu, India.
Introduction: Breast cancer is the commonest cancer among women in India and the leading cause of cancer related deaths. In patients with invasive breast cancer, axillary nodal metastasis remains as the most important predictive factor for recurrence and survival, despite progression made in molecular and genetic characterisation of these cancers.
Aim: To know the nodal positivity rate and pathologic predictive factors of nodal positivity in early breast cancer in Indian patients, which may help in predicting the axillary status preoperatively.
Materials and Methods: This study was retrospective review of patients treated in Cancer Institute, Chennai, Tamil Nadu, India between January 2011 to October 2014 for invasive breast cancer which were clinical T1 and T2 and either N0 or N1. Pathologic characteristics of the primary tumour such as size, centricity, histological type, nuclear grade, and Lympho Vascular Invasion (LVSI), Estrogen receptor (ER) and Progesterone Receptor (PR) Status, Human Epidermal growth factor Rector 2 (HER-2)/neu and Ki-67 were analysed and correlated to nodal positivity using univariate and multivariate analysis.
Results: In the univariate analysis using chi-square test, Pathological T stage, number of tumours, LVSI, ER and PR status emerged as significant variables. Variables like pT2 (p-0.032), multiple tumours (p-0.007), LVI (p<0.0001), ER positive (p-0.002) and PR positive (p-0.001) and HER2 -2+ (p-0.040) was found to have positive predictive value with statistical significance. On multivariate analysis, LVSI proved to be a highly significant predictor of positive nodes.
Conclusion: Although variables such as pT2, multiple tumours, LVSI, ER positive, PR positive and HER2+ was found to have positive predictive value with statistical significance, only LVSI emerged as significant independent predictive factors of positive lymph node.