Implications of extracapsular nodal metastases for treatment and prognosis of breast cancer

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Abstract
Background. Extracapsular extension of nodal metastases from cancer of the breast is a frequent histologic finding, but its significance for prognosis and treatment is unclear. Methods. One hundred forty-three patients with breast cancer who had metastases to axillary lymph nodes were identified and divided into two groups: those with entirely intracapsular metastases (ICM), and those with extracapsular metastases (ECM). Results. ECM was found in 58.7% of patients. A direct correlation was found between ECM and both the number of metastases and their size. Overall survival was significantly lower in patients with ECM, but an influence on survival independent of node count could be demonstrated only in patients with one to three involved nodes. ECM did not influence the pattern (i.e., locoregional versus distant) of recurrence and was not associated with increased recurrence in the axilla. Radiation therapy reduced locoregional failures in both ICM and ECM groups, but it did not improve survival. Conclusions. It is concluded that ECM has limited influence on prognosis independent of the number of positive nodes and is not an indication for radiation therapy of the axilla after a complete axillary dissection.