THE PROGNOSTIC-SIGNIFICANCE OF THE AXILLARY APEX BIOPSY IN CLINICALLYOPERABLE BREAST-CANCER

To evaluate the prognostic significance of the axillary apex biopsy an d its impact on clinical practice, a retrospective analysis was perfor med in 875 patients with clinically operable breast cancer who underwe nt this procedure from 1977 to 1985 (165 TNM stage I; 512 TNM, stage I I; 198 TNM stage IIIA). Apex biopsy is performed as a staging procedur e. Apex biopsy positive patients are treated by radiotherapy alone, wh ile apex biopsy negative patients are treated with breast conserving t herapy or mastectomy, both including complete axillary dissection. The apex biopsy was tumour positive in 4% of TNM stage I patients; 17% of stage II patients and 40% of stage IIIA patients. Among patients with clinically node-negative disease, the apex biopsy was positive in 12% ; in patients with palpable suspected lymph nodes this figure was 45%. Actuarial 8 y survival rates for patients with stage I, II and III di sease and a negative apex biopsy were 83, 70 and 50%, respectively. Th e corresponding figures for patients with a positive apex biopsy were 60, 28 and 14%. In a multivariate analysis, a positive apex biopsy, cl inical N classification and T classification were independent prognost ic factors for survival (P < 0.0001). We conclude that a positive apex biopsy is rare in clinical stage I breast cancer, and that in patient s with TNM stage II and III disease the procedure is an important tool to assess prognosis pre-operatively.