Axillary node status in nonpalpable breast cancer

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Abstract
Background: The metastatic status of the axillary nodes is prognostically important but its value has been questioned in the management of nonpalpable breast tumors. This study correlates the incidence of positive nodes with the size of the primary nonpalpable tumors. Methods: We retrospectively analyzed 220 invasive and 21 microinvasive breast cancers that were excised after needle localization and for which axillary dissections were subsequently performed. Of invasive cancers, 166 presented as mass lesions with or without microcalcifications and 54 as microcalcifications alone. The size of the mass lesions (n=166) was determined mammographically and on pathologic specimens. They were subdivided into five groups according to diameter: (a) ⩽5 mm, (b) 6–10 mm, (c) 11–20 mm, (d) >20 mm, and (e) unrecorded size. Results: Axillary metastases were found in 9% of patients whose cancer presented as microcalcifications alone. They were found in 0, 11, and 22% of patients in mammographic groups, a, b, and c, respectively. In the corresponding groups in which size was determined from the pathology report, metastases were found in 5, 10, and 27%. Conclusion: The size of nonpalpable breast cancers measured on the excised gross specimen and by mammogram accurately predicts the likelihood of axillary node metastasis.