Does Angiosarcoma of the Breast Need Nodal Staging? J Am Coll Surg 2022 May 01;234(5):774-782
Date
04/16/2022Pubmed ID
35426390Pubmed Central ID
PMC9309687DOI
10.1097/XCS.0000000000000131Scopus ID
2-s2.0-85128320047 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Breast angiosarcoma is a rare malignancy classically associated with hematogenous metastases. We sought to determine the prevalence of pathologic nodal involvement in patients with nonmetastatic, resected breast angiosarcoma and its association with overall survival.
STUDY DESIGN: The National Cancer Database was used to identify patients with nonmetastatic angiosarcoma of the breast who underwent surgical resection from 2004 to 2017. The prevalence of regional lymph node operation and nodal positivity was calculated. The Kaplan-Meier method was used to evaluate overall survival among node-positive and node-negative patients. Cox proportional hazard modeling was used to evaluate the adjusted association of nodal positivity with overall survival.
RESULTS: We included 991 patients with angiosarcoma. The median age was 69 years (interquartile range 57 to 78), and the cohort was 99% female. A total of 298 patients (30%) had pathologic regional nodal evaluation. Of those, 15 (5.0%) had positive regional lymph nodes. Node-positive patients had significantly worse survival than patients with negative regional lymph nodes. After adjusting for patient, tumor, and treatment factors, a positive regional lymph node was associated with worse overall survival compared with patients with no nodal evaluation (hazard ratio 3.20; 95% CI 1.75 to 5.86; p < 0.001).
CONCLUSIONS: Patients with nonmetastatic angiosarcoma of the breast have a 5% regional lymph node positivity rate, which is at a common threshold to consider evaluation, and identifies patients with poor survival. A prospective study to determine performance characteristics of sentinel lymph node biopsy is warranted.
Author List
Herb J, Maduekwe UN, Goel N, Rosenberger LH, Spanheimer PMAuthor
Ugwuji N. Maduekwe MD Associate Dean, Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedBreast Neoplasms
Female
Hemangiosarcoma
Humans
Lymph Node Excision
Lymph Nodes
Male
Neoplasm Staging
Prospective Studies
Sentinel Lymph Node Biopsy