The age of the patient, the size of the primary tumor in centimeters, number of involved SLNs and NSLNs, size and location of metastasis in SLNs and NSLNs, presence or absence of angiolymphatic invasion, tumor histologic type (invasive ductal, invasive lobular, other), tumor grade (I, II, III), estrogen receptor status (estrogen receptor-positive, estrogen receptornegative), and HER2 status (HER2+, HER2-) were also evaluated for each case.
The average number of NSLNs removed was 12 (range, 2-35 nodes).
ITCs had additional findings (ITCs, MM, or MET) in their NSLNs, which correlates with previous published data showing rates ranging from 7% to 19%.
Significant univariate predictors of positive NSLNs in our present study included patients with 2 or more involved SLNs.
The use of CK IHC on NSLNs from axillary dissections did not add additional diagnostic or staging information, and this approach should be reserved for the evaluation of SLNs only.
Studies have found the incidence of positive nonsentinel lymph nodes (NSLNs) in patients who presented with ITCs in their SLNs to range from 7% to 19%.8-18 Routine pathologic examination of the NSLNs has been found to show an incidence of micrometastasis (MM) and metastasis (MET) ranging from 8% to 45%.11,15,17 Variables analyzed to understand whether they predict positive NSLNs have included tumor size, number of positive SLNs, number of SLNs examined, lymphovascular invasion, and tumor grade.15,17,18,19 Collectively, these studies have shown mixed conclusions with no generally accepted nomogram developed to date.
with ITCs in their SLNs, only 2 of the 6 patients had a MM or MET in their NSLNs, which resulted in a change of their pathologic stage (pN0i+ to pN1).
Eleven patients had MET in their SLNs, 2 of which (18%) had additional MET in their NSLNs. This resulted in a pathologic stage modification in one of these patients due to an increase in the overall number of positive nodes (pT3 pN1 to pT3 pN2).