Vol 70, No 5 (2020)
Review paper
Published online: 2020-09-10

open access

Page views 1661
Article views/downloads 1709
Get Citation

Connect on Social Media

Connect on Social Media

Breast cancer – extracapsular extension in the sentinel lymph node

Piotr Kędzierawski1
Nowotwory. Journal of Oncology 2020;70(5):203-205.


Invasive breast cancer is the most common malignancy in women. At present, in the majority of cases it is recognized at an early stage. Its most common site of metastasis is the axilla region, and for women without clinically suspected lymph nodes a sentinel lymph node biopsy (SLNB) is the method of choice in diagnostics and treatment process. It allows, in many cases, axillary lymphadenectomy to be avoided and the risk of complications after a surgical treatment to be dimi­nished. Extracapsular extension (ECE) of nodal metastasis, defined as extension of cancer cells through the nodal capsule, is an important prognostic factor. The aim of this paper is to review the literature on ECE in the sentinel lymph node (SLN).

Article available in PDF format

View PDF Download PDF file


  1. Giuliano AE, Ballman KV, McCall L, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011; 305(6): 569–575.
  2. Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010; 252(3): 426–32; discussion 432.
  3. Rutgers E, Donker M, Straver M, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: Final analysis of the EORTC AMAROS trial (10981/22023). J Clin Oncol. 2013; 31(18_suppl): LBA1001–LBA1001.
  4. Voduc KD, Cheang MCU, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010; 28(10): 1684–1691.
  5. Ribelles N, Perez-Villa L, Jerez JM, et al. Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index. Breast Cancer Res. 2013; 15(5): R98.
  6. La Verde N, Biagioli E, Gerardi C, et al. Role of patient and tumor characteristics in sentinel lymph node metastasis in patients with luminal early breast cancer: an observational study. Springerplus. 2016; 5: 114.
  7. Ding J, Jiang Li, Wu W. Predictive Value of Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in Early Breast Cancer. Med Sci Monit. 2017; 23: 4102–4108.
  8. Liu Z, Sahli Z, Wang Y, et al. Young age at diagnosis is associated with worse prognosis in the Luminal A breast cancer subtype: a retrospective institutional cohort study. Breast Cancer Res Treat. 2018; 172(3): 689–702.
  9. Lian W, Fu F, Lin Y, et al. The Impact of Young Age for Prognosis by Subtype in Women with Early Breast Cancer. Sci Rep. 2017; 7(1): 11625.
  10. Gooch J, King TA, Eaton A, et al. The extent of extracapsular extension may influence the need for axillary lymph node dissection in patients with T1-T2 breast cancer. Ann Surg Oncol. 2014; 21(9): 2897–2903.
  11. Chae AW, Vandewalker KM, Li YJ, et al. Quantitation of sentinel node metastatic burden and Her-2/neu over-expression accurately predicts residual axillary nodal involvement and extranodal disease in breast cancer. Eur J Surg Oncol. 2013; 39(6): 627–633.
  12. Cardoso F, Kyriakides S, Ohno S, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019; 30(8): 1194–1220.
  13. Lebert JM, Lester R, Powell E, et al. Advances in the systemic treatment of triple-negative breast cancer. Curr Oncol. 2018; 25(Suppl 1): S142–S150.
  14. Dawson SJ, Provenzano E, Caldas C. Triple negative breast cancers: clinical and prognostic implications. Eur J Cancer. 2009; 45 Suppl 1: 27–40.
  15. Gangi A, Mirocha J, Leong T, et al. Triple-negative breast cancer is not associated with increased likelihood of nodal metastases. Ann Surg Oncol. 2014; 21(13): 4098–4103.
  16. Pilewskie M, Morrow M. Axillary Nodal Management Following Neoadjuvant Chemotherapy: A Review. JAMA Oncol. 2017; 3(4): 549–555.
  17. Kędzierawski P, Bocian A, Radowicz-Chil A. Factors influencing the presence of metastases in non-sentinel nodes in breast cancer patients with a positive sentinel node. Med Sci. 2019; 7(9): 113–119.
  18. Goyal A, Douglas-Jones A, Newcombe RG, et al. ALMANAC Trialists Group. Predictors of non-sentinel lymph node metastasis in breast cancer patients. Eur J Cancer. 2004; 40(11): 1731–1737.
  19. Fujii T, Yanagita Y, Fujisawa T, et al. Implication of extracapsular invasion of sentinel lymph nodes in breast cancer: prediction of nonsentinel lymph node metastasis. World J Surg. 2010; 34(3): 544–548.
  20. Gorgulu S, Can MF, Yagci G, et al. Extracapsular extension is associated with increased ratio of metastatic to examined lymph nodes in axillary node-positive breast cancer. Clin Breast Cancer. 2007; 7(10): 796–800.
  21. Meretoja TJ, Audisio RA, Heikkilä PS, et al. International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases. Breast Cancer Res Treat. 2013; 138(3): 817–827.
  22. Palamba HW, Rombouts MC, Ruers TJ, et al. Extranodal extension of axillary metastasis of invasive breast carcinoma as a possible predictor for the total number of positive lymph nodes. Eur J Surg Oncol. 2001; 27(8): 719–722.
  23. Vane MLG, Willemsen MA, van Roozendaal LM, et al. Extracapsular extension in the positive sentinel lymph node: a marker of poor prognosis in cT1-2N0 breast cancer patients? Breast Cancer Res Treat. 2019; 174(3): 711–718.
  24. Schwentner L, Dayan D, Wöckel A, et al. Is extracapsular nodal extension in sentinel nodes a predictor for nonsentinel metastasis and is there an impact on survival parameters?-A retrospective single center cohort study with 324 patients. Breast J. 2018; 24(4): 480–486.
  25. Nottegar A, Veronese N, Senthil M, et al. Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis. Eur J Surg Oncol. 2016; 42(7): 919–925.
  26. Veronese N, Nottegar A, Pea A, et al. Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer: a systematic review with meta-analysis. Ann Oncol. 2016; 27(1): 42–48.
  27. Luchini C, Veronese N, Pea A, et al. Extranodal extension in N1-adenocarcinoma of the pancreas and papilla of Vater. Eur J Gastroenterol Hepatol. 2016; 28(2): 205–209.
  28. Veronese N, Luchini C, Nottegar A, et al. Prognostic impact of extra-nodal extension in thyroid cancer: A meta-analysis. J Surg Oncol. 2015; 112(8): 828–833.
  29. Flaming ID, Cooper JS, Henson DE. et al. (ed.). AJCC Cancer Staging Manual 5th edition. Lippincott Raven Publishers, Philadelphia 1997.
  30. Drinka E, Allen P, McBride A, et al. Metastatic Tumor Volume and Extranodal Tumor Extension: Clinical Significance in Patients With Stage II Breast Cancer. Arch Pathol Lab Med. 2015; 139(10): 1288–1294.
  31. Choi AH, Surrusco M, Rodriguez S, et al. Extranodal extension on sentinel lymph node dissection: why should we treat it differently? Am Surg. 2014; 80(10): 932–935.
  32. Shigematsu H, Taguchi K, Koui H, et al. Clinical Significance of Extracapsular Invasion at Sentinel Lymph Nodes in Breast Cancer Patients with Sentinel Lymph Node Involvement. Ann Surg Oncol. 2015; 22(7): 2365–2371.
  33. Choi AH, Blount S, Perez MN, et al. Size of Extranodal Extension on Sentinel Lymph Node Dissection in the American College of Surgeons Oncology Group Z0011 Trial Era. JAMA Surg. 2015; 150(12): 1141–1148.
  34. Barrio AV, Downs-Canner S, Edelweiss M, et al. Microscopic Extracapsular Extension in Sentinel Lymph Nodes Does Not Mandate Axillary Dissection in Z0011-Eligible Patients. Ann Surg Oncol. 2020; 27(5): 1617–1624.
  35. Kanyılmaz G, Fındık S, Yavuz BB, et al. The Significance of Extent of Extracapsular Extension in Patients with T1-2 and N1 Breast Cancer. Eur J Breast Health. 2018; 14(4): 218–224.

Nowotwory. Journal of Oncology