Non-sentinel lymph node involvement in XXXX with @entity0 and sentinel node micrometastasis; too early to abandon axillary clearance.

@entity1 @entity5 @entity0 @entity3
AIMS: It has been suggested that @entity1 with T1-2 @entity0 and sentinel node (SLN) micrometastases, defined as foci of @entity5 cells smaller than 2 mm, may be spared completion axillary lymph node dissection because of the low incidence of further @entity3 . To gain insight into the extent of non-sentinel lymph node (n-SLN) involvement, SLNs and complementary axillary clearance specimens in @entity1 with SLN micrometastases were examined. METHODS: A set of 32 @entity1 with SLN micrometastases was selected on the basis of pathology reports and review of SLNs. Five hundred and thirteen n-SLNs from the axillary clearance specimens were serially sectioned and analysed by means of immunohistochemistry for @entity3 . Lymph node @entity3 were grouped as macrometastases (> 2 mm), and micrometastases (< 2 mm), and further subdivided as @entity5 cells (ITCs) or clusters. RESULTS: In 11 of 32 @entity1 , one or more n-SLN was involved. Grade 3 @entity5 and @entity5 > 2 cm (T2-3 v T1) were significantly associated with n-SLN micrometastases as clusters (grade: odds ratio (OR), 8.3; 95% confidence interval (CI), 1.4 to 50.0; size: T2-3 @entity5 v T1: OR, 15; 95% CI, 2.18 to 103.0). However, no subgroup of @entity5 with regard to size and grade was identified that did not have n-SLN @entity3 . CONCLUSIONS: In @entity1 with @entity0 and SLN micrometastases, n-SLN involvement is relatively common. The incidence of metastatic clusters in n-SLN is greatly increased in @entity1 with T2-3 @entity5 and grade 3 @entity5 . Therefore, axillary lymph node dissection is especially warranted in these @entity1 . However, because n-SLN @entity3 also occur in T1 and low grade @entity5 , even these should be subjected to routine axillary dissection to achieve local control.
