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Isha A. Mustafa, MD; Bernard Cole, PhD; Harold J. Wanebo, MD; Kirby I. Bland, MD; Helena R. Chang, MD, PhD

Arch Surg. 1997;132(4):384-391.

Abstract
Objective
To establish a model based on risk factor analysis to guide selective axillary lymph node dissection in patients with T1a and T1b breast cancers.

Design
Retrospective review to determine histopathologic features and patient demographic profiles that may influence the incidence of nodal metastases.

Setting
Primary care and referral centers in Rhode Island and Massachusetts.

Patients
Women with invasive breast cancers with nodal status reported to the statewide tumor registry, the Hospital Association of Rhode Island, and the tumor registry at Baystate Medical Center, Springfield, Mass, between January 1984 and December 1995. There were 12 030 patients with breast cancer reported; 2185 (18%) of these had tumors 1 cm or less in diameter.

Interventions
None.

Main Outcomes Measure
Axillary node metastases.

Results
The nodal status of 377 patients with T1a tumors and 1808 patients with Tib tumors was studied. Seventy-five percent had axillary dissections, and 16% were found to have nodal metastases. Thirty-one percent (29/93) of patients younger than 40 years had positive nodes compared with 15% (241/1546) of older patients (P=.001). The T1a tumors had fewer metastases than the Tib tumors did (11% vs 17%; P=.02). Nuclear grade was available in 49% of cases. Nuclear grades 2 and 3 were associated with nodal involvement twice as often as grade 1 tumors were (P=.002). Patients with no poor prognostic factors had a 7% or less chance of nodal involvement, while patients with all 3 poor prognostic indicators had a 33.5% chance of nodal involvement.

Conclusions
Selective nodal dissection may be possible through risk factor analysis. Prospective registration of complete histopathologic information will allow more comprehensive analysis and may further enhance the selective treatment of patients with minimally invasive breast cancer.

Arch Surg. 1997;132:384-391

Author Affiliations
From the Division of Surgical Oncology (Drs Mustafa, Wanebo, and Chang), the Department of Surgery, (Dr Bland), and the Center for Statistical Sciences (Dr Cole), Brown University, Providence, RI.

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