Ann Surg Treat Res.  2022 Jun;102(6):306-312. 10.4174/astr.2022.102.6.306.

Low incidence of lymph node metastasis in patients with microinvasive breast cancer: a Korean nationwide study

• Paik PS
• Paik NS
• Lee ES
• Choi JE
• Jeong J
• Youn HJ
• Yoon CI
• Bae SY
• Yoo TK
• Korean Breast Cancer Society

• KMID: 2530384
• DOI: http://doi.org/10.4174/astr.2022.102.6.306

Abstract

Purpose
Microinvasive breast cancer (MIBC) is an invasive carcinoma with a tumor dimension not exceeding 1 mm. Owing to its low incidence, the rate of axillary node metastasis and its management are not well established. The aim of this study was to assess the incidence of lymph node metastasis (LNM) and identify variables associated with LNM, as well as to evaluate the need for axillary staging in MIBC patients by analyzing nationwide data.
Methods
The Korean Breast Cancer Society registry was searched to identify MIBC patients diagnosed between January 1996 and April 2020. Patients without neoadjuvant chemotherapy experiences, systemic metastasis, and missing or discordant data were eligible for the analysis. The incidence rate of LNM was determined, and variables associated with LNM were identified by multivariable regression analysis.
Results
Of 2,427 MIBC patients identified, 98 (4.0%) had LNM and 12 (0.5%) had N2/3 disease. Type of breast operation (odds ratio [OR], 2.093; 95% confidence interval [CI], 1.332–3.290; P = 0.001), age (OR, 2.091; 95% CI, 1.326–3.298; P = 0.002), hormone receptor status (OR, 2.220; 95% CI, 1.372–3.594; P = 0.001), and lymphovascular invasion (OR, 11.143; 95% CI, 6.354–19.540; P < 0.001) were significantly related to LNM.
Conclusion
The incidence of LNM in MIBC patients was only 4.0% in our study, suggesting that de-escalation of axillary surgical interventions could be carefully considered. The indications for axillary staging should be individualized considering tumor volume, age, hormone receptor status, and lymphovascular invasion to improve the quality of life of MIBC survivors.

Keyword

Axilla; Breast neoplasms; Lymphatic metastasis; Microinvasive; Sentinel lymph node biopsy

Figure

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  Fig. 1 Flowchart of the microinvasive breast cancer (MIBC) patients included in our study from the Korean Breast Cancer Society (KBCS) registry database KBCS.

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  Fig. 2 Flowchart of lymph node metastasis in microinvasive breast cancer (MIBC) patients treated between 1997 and 2020. N0(i+), N isolated tumor cell clusters; N1micro, N1 micrometastasis; N1macro, N1 macrometastasis.

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