Ability of Clinical Nodal Staging to Predict Histologic Nodal Status in Breast Cancer Patients

Abstract

Axillary lymph node metastasis is the most important prognostic factor for breast cancer. Pathologic examination of axillary lymph node dissection specimens is the gold standard for determining if the tumour has metastasized. Clinical nodal staging may help the physician to plan for management and to decide what advice to give the breast cancer patients. We studied the metastasis predictive ability of clinical lymph node staging, and tried to identify subgroups that were more reliable for clinical staging.
Patients and Methods : We did a cross-sectional study by collecting the data of patients who had their breast cancers treated at Siriraj Hospital from 1983 to 1993. The lymph node status from preoperative physical examination was compared to the pathologic result of axillary lymph node dissections.
Results : Of 1,355 breast cancer patients, 4 patients were stage 0, 224 were stage I, 891 were stage II, 161 were stage III, and 40 patients were stage IV (with 35 missing). Mean diameter of the cancer was 3.6 cm. The average age at diagnosis was 48.5 years. Fifty one percent (697 patients) had at least one palpable node from preoperative physical examination, and 50% of cases (678 patients) had pathologic axillary lymph node positive for metastasis. When compared to pathologic examination, the accuracy of clinical lymph node staging was 70.6%, with 70% sensitivity and 71% specificity. The accuracy was increased in patients with small (T1) or large primary tumor (T3,4) subgroups.
Conclusion : Physical examination of axillary lymph node could be used as a guide for predicting metastasis of breast cancer, but with 25-30% of uncertainty.