Our clinical results of sentinel lymph node in early stage breast cancer patients

The condition of axillary lymph nodes is the most important prognostic factor in breast cancer. Therefore, determining of the condition of axilla is an indispensable part of the breast cancer surgery. However, the most important morbidity reason in the breast cancer surgery is the dissection of axillary lymph nodes. In 10-30% of early-stage breast cancer patients who are nonpalpable axillary lymph node in clinical examination, spread of disease is diagnosed in the region axillary but in the other cases axillary dissection is done unnecessarily. In these patients, biopsy of sentinel lymph nodes is commonly used for staging of the axilla tumors. Purpose: In patients with early-stage breast cancer and nonpalpable axillary lymph nodes, we aimed to investigate whether the prognostic factors (age, the condition of hormone receptor, grade, diameter of the tumor, histological subtype, tumor localization) have an effect on the lymph node involvement. Equipment and method: This retrospective study has been made on 131 patients with early stage breast cancer admitted to Dicle University Medicine Faculty General Surgery section between January 2011 and January 2015. In patients with early-stage breast cancer and nonpalpable axillary lymph nodes, it was researched influence of the prognostic factors on the involvement axillary lymph nodes. It was used SPSS (statistical package for social sciences) for windows 15.0 program for statistical analyses. Some tests (descriptive statistical methods, student-t, Mann-Whitney U and logistic regression) were used to evaluate the data of the study. The odds ratio was calculated for each variance and for all variances P< 0.05 was considered statistically significant. Findings: The patients were separated to groups according to age, tumor localization, histological subtype, hormone receptor positivity, grade, tumor diameter and axillary involvement. The youngest age of patients was 31 and the oldest was 79. Of 131 tumors, 49.4 % was in the right breast and 50.6% was in the left breast. Of 105 tumors, 80.2% was invasive ductal carcinoma. The tumor localization was upper-outer quadrant in 83 (63.4%) patients. Whereas estrogen receptor positivity was positive in 86 (65.6 %) patients, it was negative in 45 (34.4%) patients. Whereas progesterone receptor positivity was positive in 81 (61.8%) patients, it was negative in 50 (38.2%) patients. Cerb-B2 receptor was positive in 98 (74.8%) patients, but it was negative in 33 (25.2%) patients. In the sentinel lymph node biopsy, axillary involvement was positive in 58 patients, but it was negative in 73 patients. The relationship of sentinel lymph node positivity with prognostic factors ("histological subtypes," "tumor diameter" and "grade") was assessed by logistic regression test. Sentinel lymph node positivity of the early stages of tumor (T1 and T2) was significantly lower than that of T3 tumors (p = 0.032). The sentinel lymph node positivity of grade 1 and 2 tumors was significantly lower than that of the grade 3 tumors (p = 0.029). However, no statistically significant differences were found among different histological types of breast cancer (p = 0.999). Results: In this study, in patients with early-stage breast cancer and nonpalpable axillary lymph nodes, prognostic factors such as the age, hormone receptor status, histological subtypes, and tumor localization were not found to have an impact on axillary lymph node invasion. However, it was determined that tumor size and tumor grade were effective in the axillary lymph node involvement. Key words: Breast cancer, axillary involvement and prognostic factors.