The role of lymphatic and vascular invasion in lymph node metastasis in T1/T2N0 breast cancer patients at sanglah general hospital

Breast cancer is still a significant public health problem worldwide. It is the most common cancer in the female population, and second cause of mortality after lung cancer. In Indonesia, breast cancer was second to cervical cancer, with high mortality, because of the late stage at presentation of health facilities. Since mass screening program for breast cancer was established in the western world, the earlier breast cancer was detected, the incidence of ductal carcinoma in situ and non palpable breast cancers were increased a great deal. The more conservative surgeries were becoming the surgical technique of choice, such as BCT or breast conserving surgery. The small percentage of axillary lymph node positivity, was now become a controversy, looking at the morbidity it caused. At Sanglah Hospital, even though mass screening project for breast cancer was not available, and most breast cancer patients came at a late stage (70–80% came at stage III to IV), the need to determine the axillary lymph node status was quite important especially in early breast cancer (T1/T2N0M0) in our population. Lymphatic Mapping (LM) and Sentinel Lymph node Biopsy (SLNB) was not yet established in our institution. Therefore, in this study, we tried to define the correlation between histologic grading, tumor infiltrating lymphocytes (TIL), vascular invasion (IV), lymphatic invasion (LI), the presence or absence of comedo subtype component in the breast cancer histopathology, with the presence of axillary lymph node metastasis in the T1/T2N0M0 breast cancers. Since 2002 until 2004 (24 months), a cross sectional study on T1/T2N0M0 breast cancers was performed. The correlation between histologic grading, TIL, VI, LI, the presence or absence of comedo component with axillary lymph node metastasis was analyzed. The results were, that lymphatic invasion was the strongest predictor in correlation with the axillary lymph node metastasis (p< 0.00), therefore the lymphatic invasion was a strong indicator for an axillary lympnodes dissection procedure in the management of T1/T2N0M0 breast cancers, in the institutions where LM and SLNB were not readily available. Other variables did not show any strong correlation, but this might be due to too small sample units we recruited.