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.
|case and control||multiplicity||size(ave)♦||≥ T2||fibrosis||ER+||Her-2:3+||EIC|
|fN0||35.8 %||19.2 mm||34.3 %||44.4 %||90.1 %||8.6 %||15.9 %|
|pN0||22.3 %||15.9mm||21.7 %||23.6 %||81.1 %||11.4 %||17.3 %|