[176] Imaging and Pathology Discrepancies in Lymph Node Evaluation of Mammary Carcinoma

Masako Kasami, Takayoshi Uematsu, Takuma Oichi, Masato Abe. Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan

Background: Rapid advances in imaging and molecular diagnosis have raised questions about the value of TNM staging, especially in mammary carcinoma. However, as one of the important prognostic factors and as determining factors for systemic adjuvant therapy, pathologic examination of lymph nodes is recommended.
Design: From 2002 to 2007, 649 cases of mammary invasive carcinoma were classified as N0 (Clinically negative lymph nodes) by using MRI and/or CT in our hospital. We compared 151 cases with pathologically positive lymph nodes (fN0) in N0 and 498 cases with pathologically negative lymph nodes (pN0) in N0, regarding the size of primary invasive carcinoma, histologic grade, ER, Her-2, fibrosis, multiplicity and extensive intraductal component (EIC, defined more than 50mm in the greatest extent).
Results: The average patient age was 56 years in both groups. Invasive lobular carcinoma was diagnosed in 9 patients (6%) of fN0 patients and in 24 of pN0 patients. The histologic grade 3 was diagnosed in 37 of fN0 patients and in 120 of pN0 patients. The size of metastases was averaged 4.2mm(range 0.3-12.0mm) in fN0 which was subdivided in pNmi(n=47cases), pN1a(n=93), pN1b(n=1), pN2(n=7) and pN3(n=3).There were 9 deaths in pN0 cases and 2 of fN0 cases (median follow up period: 75 months) and 10 cases were died of hematogenious metastases. No significant survival differences were detected between pN0 and fN0 cases by Kaplan Meier Method.Table 1 shows the results.

Table 1. Comparison of fN0 and pN0 cases
case and controlmultiplicitysize(ave)♦≥ T2fibrosisER+Her-2:3+EIC
fN035.8 %19.2 mm34.3 %44.4 %90.1 %8.6 %15.9 %
pN022.3 %15.9mm21.7 %23.6 %81.1 %11.4 %17.3 %
p value<0.0010.00010.0001<0.00010.010.3250.693
PearsonΧ²but Mann-Whitney♦, fN0:false positive N0, ave:average

Conclusions: Multiplicity, large size, ER positivity and fibrosis were related in positive lymph nodes. However, microscopic disease in the lymph nodes of mammary carcinoma could not be considered a prognostic factor in comparison with imaging diagnosis in this study. For long term survival analysis, further studies are required.
Category: Breast

Wednesday, March 21, 2012 9:30 AM

Poster Session V # 12, Wednesday Morning


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