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Observational Study to Determine the Involvement of Level III Lymph Nodes in Case of Clinically Positive Level II Nodes in Carcinoma Breast

Observational Study to Determine the Involvement of Level III Lymph Nodes in Case of Clinically... Management of breast cancer has gradually shifted from era of radical surgery to present days of multimodality management and conservatism. Management of carcinoma breast is primarily multimodality of which surgery is one of the important roles to play. Our study is a prospective observational study to determine the involvement of level III axillary lymph nodes in clinically involved axilla with grossly involved lower-level axillary nodes. Underestimation of a number of involved nodes at level III shall result in inaccuracy of subset risk stratification leading to substandard prognostication. The enigma of not addressing presumably involved nodes thereby altering the staging vs acquired morbidity has always been a contentious issue. Mean lymph node harvest at the lower level (I and II) was 17.9 ± 6.3 (range: 6–32) while positive lower-level axillary lymph node involvement was 6.5 ± 6.5 (range: 1–27). The mean ± SD for level III positive lymph node involvement was 1.46 ± 1.69 (range: 0–8). Our prospective observational study though limited by the number and years of follow-up has demonstrated that the presence of more than three positive LN at a lower level increases the risk for higher nodal involvement substantially. It is also evident in our study that PNI, ECE, and LVI increased the probability of stage up-gradation. LVI was found to be a significant prognostic factor for apical LN involvement in multivariate analysis. On multivariate logistic regression > 3 pathological positive lymph nodes at the level I and II and LVI involvement elevated the risk of involvement at level III by 11 and 46 times, respectively. It is recommended that patients who have a positive pathological surrogate marker of aggressiveness should be evaluated perioperatively for level III involvement, especially in the setting of visible grossly involved nodes. The patient should be counseled and informed decision to perform complete axillary lymph node dissection with the added risk of morbidity should be contemplated. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Indian Journal of Surgical Oncology Springer Journals

Observational Study to Determine the Involvement of Level III Lymph Nodes in Case of Clinically Positive Level II Nodes in Carcinoma Breast

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References (23)

Publisher
Springer Journals
Copyright
Copyright © The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
ISSN
0975-7651
eISSN
0976-6952
DOI
10.1007/s13193-022-01618-3
Publisher site
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Abstract

Management of breast cancer has gradually shifted from era of radical surgery to present days of multimodality management and conservatism. Management of carcinoma breast is primarily multimodality of which surgery is one of the important roles to play. Our study is a prospective observational study to determine the involvement of level III axillary lymph nodes in clinically involved axilla with grossly involved lower-level axillary nodes. Underestimation of a number of involved nodes at level III shall result in inaccuracy of subset risk stratification leading to substandard prognostication. The enigma of not addressing presumably involved nodes thereby altering the staging vs acquired morbidity has always been a contentious issue. Mean lymph node harvest at the lower level (I and II) was 17.9 ± 6.3 (range: 6–32) while positive lower-level axillary lymph node involvement was 6.5 ± 6.5 (range: 1–27). The mean ± SD for level III positive lymph node involvement was 1.46 ± 1.69 (range: 0–8). Our prospective observational study though limited by the number and years of follow-up has demonstrated that the presence of more than three positive LN at a lower level increases the risk for higher nodal involvement substantially. It is also evident in our study that PNI, ECE, and LVI increased the probability of stage up-gradation. LVI was found to be a significant prognostic factor for apical LN involvement in multivariate analysis. On multivariate logistic regression > 3 pathological positive lymph nodes at the level I and II and LVI involvement elevated the risk of involvement at level III by 11 and 46 times, respectively. It is recommended that patients who have a positive pathological surrogate marker of aggressiveness should be evaluated perioperatively for level III involvement, especially in the setting of visible grossly involved nodes. The patient should be counseled and informed decision to perform complete axillary lymph node dissection with the added risk of morbidity should be contemplated.

Journal

Indian Journal of Surgical Oncology – Springer Journals

Published: Mar 1, 2023

Keywords: Axillary Lymph Nodes; Level III Lymph Node Dissection; Pathological Markers

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