TY - JOUR
T1 - Relevant impact of central pathology review on nodal classification in individual breast cancer patients
AU - Vestjens, J. H M J
AU - Pepels, M. J.
AU - De Boer, M.
AU - Borm, G. F.
AU - Van Deurzen, C. H M
AU - Van Diest, P. J.
AU - Van Dijck, J. A A M
AU - Adang, E. M M
AU - Nortier, J. W R
AU - Rutgers, E. J Th
AU - Seynaeve, C.
AU - Menke-Pluymers, M. B E
AU - Bult, P.
AU - Tjan-Heijnen, V. C G
PY - 2012/10
Y1 - 2012/10
N2 - Background: In the MIRROR study, pN0(i +) and pN1mi were associated with reduced 5-year disease-free survival (DFS) compared with pN0. Nodal status (N-status) was assessed after central pathology review and restaging according to the sixth AJCC classification. We addressed the impact of pathology review. Patients and methods: Early favorable primary breast cancer patients, classified pN0, pN0(i + ), or pN1(mi) by local pathologists after sentinel node procedure, were included. We assessed the impact of pathology review on N-status (n = 2842) and 5-year DFS for those without adjuvant therapy (n = 1712). Results: In all, 22% of the 1082 original pN0 patients was upstaged. Of the 623 original pN0(i + ) patients, 1% was downstaged, 26% was upstaged. Of 1137 patients staged pN1mi, 15% was downstaged, 11% upstaged. Originally, 5-year DFS was 85% for pN0, 74% for pN0(i + ), and 73% for pN1mi; HR 1.70 [95% confidence interval (CI) 1.27-2.27] and HR 1.57 (95% CI 1.16-2.13), respectively, compared with pN0. By review staging, 5-year DFS was 86% for pN0, 77% for pN0(i + ), 77% for pN1mi, and 74% for pN1 +. Conclusion: Pathology review changed the N-classification in 24%, mainly upstaging, with potentially clinical relevance for individual patients. The association of isolated tumor cells and micrometastases with outcome remained unchanged. Quality control should include nodal breast cancer staging.
AB - Background: In the MIRROR study, pN0(i +) and pN1mi were associated with reduced 5-year disease-free survival (DFS) compared with pN0. Nodal status (N-status) was assessed after central pathology review and restaging according to the sixth AJCC classification. We addressed the impact of pathology review. Patients and methods: Early favorable primary breast cancer patients, classified pN0, pN0(i + ), or pN1(mi) by local pathologists after sentinel node procedure, were included. We assessed the impact of pathology review on N-status (n = 2842) and 5-year DFS for those without adjuvant therapy (n = 1712). Results: In all, 22% of the 1082 original pN0 patients was upstaged. Of the 623 original pN0(i + ) patients, 1% was downstaged, 26% was upstaged. Of 1137 patients staged pN1mi, 15% was downstaged, 11% upstaged. Originally, 5-year DFS was 85% for pN0, 74% for pN0(i + ), and 73% for pN1mi; HR 1.70 [95% confidence interval (CI) 1.27-2.27] and HR 1.57 (95% CI 1.16-2.13), respectively, compared with pN0. By review staging, 5-year DFS was 86% for pN0, 77% for pN0(i + ), 77% for pN1mi, and 74% for pN1 +. Conclusion: Pathology review changed the N-classification in 24%, mainly upstaging, with potentially clinical relevance for individual patients. The association of isolated tumor cells and micrometastases with outcome remained unchanged. Quality control should include nodal breast cancer staging.
KW - Breast cancer
KW - Pathology review
KW - Sentinel node
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U2 - 10.1093/annonc/mds072
DO - 10.1093/annonc/mds072
M3 - Article
C2 - 22495317
AN - SCOPUS:84867120388
SN - 0923-7534
VL - 23
SP - 2561
EP - 2566
JO - Annals of Oncology
JF - Annals of Oncology
IS - 10
M1 - mds072
ER -