Prognostic features in patients with stage T1 breast carcinoma and a 0.5-cm or less lymph node metastasis - Significance of lymph node hilar tissue invasion

Trends in surgical practice suggest that pathologists will encounter increa sed numbers of patients with small invasive ductal adenocarcinomas, small, if any, metastatic deposits in axillary lymph nodes' (ALNs); and possibly f ewer ALN specimens to examine. New prognostic histologic features may be ne eded in this environment. We studied histologic features of primary breast carcinoma and ALN metastasis from 86 patients who had stage TI ductal carci nomas with only 1 ALN metastasis that was 0.5 cm or less and correlated the se features with the development of distant metastases to evaluate their po tential usefulness as prognostic indicators. The median follow-up period wa s 5.3 years. Distant metastases developed in 12 patients. Features signific antly associated with 10-year distant metastases-free survival were lymph n ode hilar tissue invasion (HTI) and ALN metastasis size (stage N1a vs N1b). Tumor grade 1 vs grades 2 or 3 approached significance. The presence of HT I also was related significantly to a decreased 10-year distant metastases- free survival in the stage N1b group. Our study suggests that HTI, along wi th other well-known parameters, is a useful prognostic feature. In addition , it supports the opinion that ALN dissection may provide limited additiona l information for patients with grade 1, stage Tla, invasive ductal carcino mas. Additional studies are needed to confirm our findings.