Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial

Marieke E Straver, Philip Meijnen, Geertjan van Tienhoven, Cornelis J H van de Velde, Robert E Mansel, Jan Bogaerts, Nicole Duez, Luigi Cataliotti, Jean H G Klinkenbijl, Helen A Westenberg, Huub van der Mijle, Marko Snoj, Coen Hurkmans, Emiel J T Rutgers, Marieke E Straver, Philip Meijnen, Geertjan van Tienhoven, Cornelis J H van de Velde, Robert E Mansel, Jan Bogaerts, Nicole Duez, Luigi Cataliotti, Jean H G Klinkenbijl, Helen A Westenberg, Huub van der Mijle, Marko Snoj, Coen Hurkmans, Emiel J T Rutgers

Abstract

Background: The randomized EORTC 10981-22023 AMAROS trial investigates whether breast cancer patients with a tumor-positive sentinel node biopsy (SNB) are best treated with an axillary lymph node dissection (ALND) or axillary radiotherapy (ART). The aim of the current substudy was to evaluate the identification rate and the nodal involvement.

Methods: The first 2,000 patients participating in the AMAROS trial were evaluated. Associations between the identification rate and technical, patient-, and tumor-related factors were evaluated. The outcome of the SNB procedure and potential further nodal involvement was assessed.

Results: In 65 patients, the sentinel node could not be identified. As a result, the sentinel node identification rate was 97% (1,888 of 1,953). Variables affecting the success rate were age, pathological tumor size, histology, year of accrual, and method of detection. The SNB results of 65% of the patients (n = 1,220) were negative and the patients underwent no further axillary treatment. The SNB results were positive in 34% of the patients (n = 647), including macrometastases (n = 409, 63%), micrometastases (n = 161, 25%), and isolated tumor cells (n = 77, 12%). Further nodal involvement in patients with macrometastases, micrometastases, and isolated tumor cells undergoing an ALND was 41, 18, and 18%, respectively.

Conclusions: With a 97% detection rate in this prospective international multicenter study, the SNB procedure is highly effective, especially when the combined method is used. Further nodal involvement in patients with micrometastases and isolated tumor cells in the sentinel node was similar-both were 18%.

Figures

Fig. 1
Fig. 1
Study design. Patients with clinically negative lymph nodes and tumors of

Fig. 2

Patient flow in the EORTC…

Fig. 2

Patient flow in the EORTC AMAROS trial regarding the identification and results of…

Fig. 2
Patient flow in the EORTC AMAROS trial regarding the identification and results of the SNB procedure. SN sentinel node; Macro macrometastases (>2 mm); Micro micrometastases (0.2–2 mm); ITC isolated tumor cells (<0.2 mm)

Fig. 3

Drainage to the internal mammary…

Fig. 3

Drainage to the internal mammary chain seen on lymphoscintigraphy and the subsequent surgical…

Fig. 3
Drainage to the internal mammary chain seen on lymphoscintigraphy and the subsequent surgical removal. IMC internal mammary chain
Fig. 2
Fig. 2
Patient flow in the EORTC AMAROS trial regarding the identification and results of the SNB procedure. SN sentinel node; Macro macrometastases (>2 mm); Micro micrometastases (0.2–2 mm); ITC isolated tumor cells (<0.2 mm)
Fig. 3
Fig. 3
Drainage to the internal mammary chain seen on lymphoscintigraphy and the subsequent surgical removal. IMC internal mammary chain

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