The Incidence of Breast Cancer Lymph Node Involvement in Trinidad and Tobago

TL;DR

This study examines how often breast cancer spreads to lymph nodes in Trinidad and Tobago, linking it to tumor size and staging.

Contribution

The study provides insights into lymph node involvement patterns specific to a West Indian population and evaluates sentinel lymph node biopsy effectiveness.

Findings

44.8% of cases presented at T2 stage with lymph node spread.

Larger tumors (T3 and T4) showed higher N and M staging, indicating more metastasis.

Sentinel lymph node biopsies were often negative despite significant lymph node involvement.

Abstract

Objective

This study aims to investigate breast cancer lymph node involvement in a West Indian population while correlating it with various histological parameters and evaluating the role of the sentinel lymph node biopsy.

Method

This is a retrospective study where histology reports for all breast cancer-related biopsies from 2018 to 2021, totaling 813 samples, were obtained. Histological parameters from these reports were extracted into a spreadsheet and analyzed using Statistical Product and Service Solutions (SPSS, version 28.0; IBM SPSS Statistics for Windows, Armonk, NY) software for TNM staging and axillary and sentinel lymph node dissections, among other fields found in histology reports.

Results

In 44.8% of cases, patients present at the T2 stage with associated lymph node spread. Each T stage had more lymph nodes involved than uninvolved for tumors sized T2 and higher. Inversely, for tumors staged under T2, there were generally more uninvolved lymph nodes than involved ones. Larger tumors were found to have advanced N staging, especially in the T3 category, where a significantly higher proportion of cases were found to have N2 and N3 staging compared to the other T stages. This trend is also seen in M staging, where larger tumors metastasize more than smaller tumors (40% for T4a, 0% for T1). Despite significant lymph node involvement being observed, sentinel lymph node biopsies were usually negative.

Conclusion

More patients in this population present with lymph node involvement than without. Larger breast cancer tumors are associated with greater lymph node involvement, particularly at T2 and higher stages. Sentinel lymph node biopsies can be omitted in smaller breast cancer tumors up to 2 cm in size, and the local recurrence rate is low despite a false-negative rate of around 10% in upfront sentinel lymph node biopsy.

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