Aziz, Sura Wik, Elisabeth Knutsvik, Gøril Audun Klingen, Tor Chen, Ying Davidsen, Benedicte Aas, Hans Aas, Turid A. Akslen, Lars Extra-nodal extension is a significant prognostic factor in lymph node positive breast cancer <div><p>Presence of lymph node (LN) metastasis is a strong prognostic factor in breast cancer, whereas the importance of extra-nodal extension and other nodal tumor features have not yet been fully recognized. Here, we examined microscopic features of lymph node metastases and their prognostic value in a population-based cohort of node positive breast cancer (<i>n</i> = 218), as part of the prospective Norwegian Breast Cancer Screening Program NBCSP (1996–2009). Sections were reviewed for the largest metastatic tumor diameter (TD-MET), nodal afferent and efferent vascular invasion (AVI and EVI), extra-nodal extension (ENE), number of ENE foci, as well as circumferential (CD-ENE) and perpendicular (PD-ENE) diameter of extra-nodal growth. Number of positive lymph nodes, EVI, and PD-ENE were significantly increased with larger primary tumor (PT) diameter. Univariate survival analysis showed that several features of nodal metastases were associated with disease-free (DFS) or breast cancer specific survival (BCSS). Multivariate analysis demonstrated an independent prognostic value of PD-ENE (with 3 mm as cut-off value) in predicting DFS and BCSS, along with number of positive nodes and histologic grade of the primary tumor (for DFS: <i>P</i> = 0.01, <i>P</i> = 0.02, <i>P</i> = 0.01, respectively; for BCSS: <i>P</i> = 0.02, <i>P</i> = 0.008, <i>P</i> = 0.02, respectively). To conclude, the extent of ENE by its perpendicular diameter was independently prognostic and should be considered in line with nodal tumor burden in treatment decisions of node positive breast cancer.</p></div> BCSS;extra-nodal;lymph node;lymph node metastases;CD-ENE;metastatic tumor diameter;prognostic factor;EVI;prognostic value;PT;NBCSP;ENE;nodal tumor features;AVI;breast cancer Presence;breast cancer;TD-MET;extension;PD-ENE;Univariate survival analysis;LN;DFS;nodal tumor burden 2017-02-15
    https://plos.figshare.com/articles/dataset/Extra-nodal_extension_is_a_significant_prognostic_factor_in_lymph_node_positive_breast_cancer/4655395
10.1371/journal.pone.0171853