Still, stratification of node-positive cases into different categories, based on nodal tumor features, could assist in more precise staging and improved treatment.
The study was also supported by the Norwegian Cancer Society, Helse Vest RHF, and the Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen and Vestfold Hospital Research Fund.Ĭompeting interests: The authors have declared that no competing interests exist.Īxillary lymph node metastasis is a key prognostic factor in breast cancer. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: Data are available in the supporting information.įunding: This work was partly supported by the Research Council of Norway through its Centre of Excellence funding scheme, project number 223250 (received by LA). Received: NovemAccepted: JanuPublished: February 15, 2017Ĭopyright: © 2017 Aziz et al. PLoS ONE 12(2):Įditor: Yves St-Pierre, Institut national de la recherche scientifique, CANADA (2017) Extra-nodal extension is a significant prognostic factor in lymph node positive breast cancer. To conclude, the extent of ENE by its perpendicular diameter was independently prognostic and should be considered in line with nodal tumor burden in treatment decisions of node positive breast cancer.Ĭitation: Aziz S, Wik E, Knutsvik G, Klingen TA, Chen Y, Davidsen B, et al. Multivariate analysis demonstrated an independent prognostic value of PD-ENE (with 3 mm as cut-off value) in predicting DFS and BCSS, along with number of positive nodes and histologic grade of the primary tumor (for DFS: P = 0.01, P = 0.02, P = 0.01, respectively for BCSS: P = 0.02, P = 0.008, P = 0.02, respectively). Univariate survival analysis showed that several features of nodal metastases were associated with disease-free (DFS) or breast cancer specific survival (BCSS). Number of positive lymph nodes, EVI, and PD-ENE were significantly increased with larger primary tumor (PT) diameter. Sections were reviewed for the largest metastatic tumor diameter (TD-MET), nodal afferent and efferent vascular invasion (AVI and EVI), extra-nodal extension (ENE), number of ENE foci, as well as circumferential (CD-ENE) and perpendicular (PD-ENE) diameter of extra-nodal growth. Here, we examined microscopic features of lymph node metastases and their prognostic value in a population-based cohort of node positive breast cancer ( n = 218), as part of the prospective Norwegian Breast Cancer Screening Program NBCSP (1996–2009). Presence of lymph node (LN) metastasis is a strong prognostic factor in breast cancer, whereas the importance of extra-nodal extension and other nodal tumor features have not yet been fully recognized.
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