Management of the axilla in patients with breast cancers one centimeter or smaller

K. J. Halverson, M. E. Taylor, C. A. Perez, D. M. Garcia, R. Myerson, G. Philpott, J. Levy, J. R. Simpson, G. Tucker, C. Rush

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    57 Scopus citations

    Abstract

    Very small breast cancers are being diagnosed with increased frequency, and, until recently, little information regarding the incidence of axillary lymph node metastases in these most favorable tumors was available. Moreover, scarce data exist regarding axillary failure in this cohort as a function of initial treatment, be it surgery, radiation, or simply observation. In the present study, limited to women with invasive cancers measuring no more than 10 mm, the incidence of pathologically positive axillary nodes was 12.3%. The incidence of nodal metastases was influenced by tumor size (albeit not quite significantly, p = .08): not one patient with a tumor ± 5 mm had axillary node metastases, compared to 14.7% in those with cancers 6 to 10 mm. The histologic grade and tumor location were also important in predicting nodal positivity. The incidence of positive nodes was 38% in those with poorly differentiated cancers, compared to 8% and 7% in women with well and moderately differentiated cancers, respectively, p = .03. Axillary nodal positivity was seen in 17% of outer quadrant vs 3% of central and inner quadrant primaries, p < .01. The axilla was managed with surgery alone (76%), radiation alone (6%), surgery and radiation (6%), or simply observation (10%). With a median follow-up of 55 months, not one patient has suffered a nodal recurrence, and in our experience, survival free of distant relapse was not adversely affected by the omission of axillary surgery.

    Original languageEnglish
    Pages (from-to)461-466
    Number of pages6
    JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
    Volume17
    Issue number6
    DOIs
    StatePublished - 1994

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