Distance Between the Tumour and Nipple as a Predictor of Axillary Lymph Node Involvement in Breast Cancer

Figures & data

Table 1 Patient and Tumor Characteristics Comparisons Between Patients with and without Axillary Lymph Node Metastasis

Characteristics	Overall (n=847)	Negative Axillary Involvement (n=425)	Positive Axillary Involvement (n=422)	p-value
Age at diagnosis (mean ± SD)	48.30±10.42	49.10±10.39	47.50±10.41	0.026
Tumor size, cm (mean ± SD)	2.97±1.74	2.56±1.18	3.36±2.08	<0.001
Tumor-nipple distance, cm (mean ± SD)	3.01±2.15	3.41±2.18	2.76±2.07	<0.001
T classification				<0.001
T1	28.69% (243/847)	34.59% (147/425)	22.75% (96/422)
T2	51.36% (435/847)	48.71% (207/425)	54.03% (228/422)
T3	6.38% (54/847)	2.12% (9/425)	10.66% (45/422)
T4	3.42% (29/847)	2.59% (11/425)	4.27% (18/422)
Tx	7.56% (64/847)	9.18% (39/425)	5.92% (25/422)
Unknown	2.60% (22/847)	2.82% (12/425)	2.37% (10/422)
ER status				0.876
Negative	35.77% (303/847)	36.47% (155/425)	35.07% (148/422)
Positive	62.46% (529/847)	61.65% (262/425)	63.27% (267/422)
Unknown	1.77% (15/847)	1.88% (8/425)	1.66% (7/422)
PR status				0.957
Negative	36.72% (311/847)	36.24% (154/425)	37.2% (157/422)
Positive	61.39% (520/847)	61.88% (263/425)	60.9% (257/422)
Unknown	1.89% (16/847)	1.88% (8/425)	1.9% (8/422)
HER-2 status				0.355
Negative	74.14% (628/847)	73.65% (313/425)	74.64% (315/422)
Positive	13.46% (114/847)	12.71% (54/425)	14.22% (60/422)
Uncertain	8.74% (74/847)	10.35% (44/425)	7.11% (30/422)
Unknown	3.66% (31/847)	3.29% (14/425)	4.03% (17/422)
Ki-67 expression				0.155
High expression	60.09% (509/847)	61.65% (262/425)	58.53% (247/422)
Not high expression	18.42% (156/847)	19.53% (83/425)	17.3% (73/422)
Unknown	21.49% (182/847)	18.82% (80/425)	24.17% (102/422)
Lymphovascular invasion				<0.001
Yes	2.48% (21/847)	0.47% (2/425)	4.5% (19/422)
No	97.52% (826/847)	99.53% (423/425)	95.5% (403/422)
Tumor location				<0.001
12 or 6 o’clock	12.28% (104/847)	13.18% (56/425)	11.37% (48/422)
Inner quadrants	24.32% (206/847)	30.59% (130/425)	18.01% (76/422)
Outer quadrants	55.02% (466/847)	49.41% (210/425)	60.66% (256/422)
Beneath nipple/peri areolar	4.25% (36/847)	1.88% (8/425)	6.64% (28/422)
Unknown	4.13% (35/847)	4.94% (21/425)	3.32% (14/422)

Abbreviations: SD, standard deviation; ER, estrogen receptor; PR, progesterone receptor; HER-2, human epidermal growth factor receptor 2.

Table 2 Distribution of Tumor–Nipple Distance Among Patients with and without Axillary Lymph Node Metastasis (Chi²=4.540, p=0.033)

Status of Axillary Lymph Nodes	≤30 mm	>30 mm	Total
Negative	46.72% (214/458)	56.85% (83/146)	49.17% (297/604)
Positive	53.28% (244/458)	43.15% (63/146)	50.83% (307/604)

Table 3 Distribution of Tumor–Nipple Distance Among Patients with and without Axillary Lymph Node Metastasis in Upper Outer Quadrant (Chi²=4.244, p=0.039)

Status of Axillary Lymph Nodes	≤30 mm	>30 mm	Total
Negative	42.22% (57/135)	56.47% (48/85)	47.73% (105/220)
Positive	57.78% (78/135)	43.53% (37/85)	52.27% (115/220)

Table 4 Multivariate Logistic Regression of Factors Associated with Axillary Lymph Node Involvement

Variables	OR (95% CI)	p-value
Age at diagnosis
≤40	1.00 (ref)
40–60	0.576 (0.344, 0.966)	0.036
>60	0.691 (0.352, 1.360)	0.285
Tumor–nipple distance
≤30 mm	1.00 (ref)
>30 mm	0.561 (0.377, 0.835)	0.004
T stage
1	1.00 (ref)
2	1.573 (1.045, 2.369)	0.030
3–4	1.848 (0.892, 4.119)	0.133
ER status
Positive	1.00 (ref)
Negative	0.722 (0.415, 1.255)	0.248
PR status
Positive	1.00 (ref)
Negative	1.021 (0.602, 1.733)	0.939
HER-2 status
Positive	1.00 (ref)
Negative	1.142 (0.675, 1.932)	0.621
Uncertain	0.858 (0.399, 1.847)	0.695
Ki-67 expression
High	1.00 (ref)
Low	0.932 (0.585, 1.486)	0.768
Lymphovascular invasion
Yes	1.00 (ref)
No	0.083 (0.011, 0.657)	0.018
Tumor location(quadrant)
12 or 6 o’clock	1.00 (ref)
Inner quadrants	0.684 (0.356, 1.313)	0.254
Outer quadrants	1.540 (0.849, 2.794)	0.155
Beneath nipple/peri areolar	2.284 (0.749, 6.963)	0.147

Abbreviations: ER, estrogen receptor; PR, progesterone receptor; HER-2, human epidermal growth factor receptor 2.

Table 5 Studies on Distance from Tumor and the Anatomical Landmarks of the Breast

First Author	Study Design	Sample Size	Anatomical Landmark	Factors That are Associated with Distance	Factors That are Not Associated with Distance	Method of Distance Measurement (Imaging Modality)	Distance Stratification (mm)	Overall Rate of Axillary Involvement
Ansari B^Citation10	Retrospective	230	Skin surface	Nodal status		Ultrasound	Each 1	24.03%
Ansari B^Citation10	Retrospective	230	Nipple	Nodal status		Ultrasound	Each 10	24.03%
Cunningham JE^Citation8	Retrospective	209	Skin surface	Nodal status		Ultrasound	≤14 vs >14; continuous	29.19%
Eom YH^Citation14	Retrospective	891	Skin surface	Nodal status	Ipsilateral recurrence; Recurrence-free survival	Ultrasound	<3 vs ≥3	32.32%
Kim WH^Citation15	Retrospective	1102	Chest wall	ER status; Nodal status		MRI	<3 vs ≥3; continuous	23.41%
Lewis EI^Citation12	Retrospective	285	Nipple		Nodal status	Mammography	NA	38.25%
Lewis EI^Citation12	Retrospective	285	Skin surface		Nodal status	Ultrasound	≤10 vs >10	38.25%
Ryu JM^Citation13	Retrospective	265	Nipple		Nodal status; Disease-free survival; Local recurrence-free survival	MRI	<20 vs ≥20	26.42%
Stallard S^Citation16	Retrospective	220	Nipple	Local recurrence		Mammography	<40 vs ≥40	–^a
Torstenson T^Citation11	Retrospective	401	Skin surface	Nodal status		Ultrasound	≤10 vs >10; each 10	19.70%
Torstenson T^Citation11	Retrospective	401	Nipple	Nodal status		Ultrasound	≤20, 20~50, >50; each 10	19.70%
The present study	Retrospective	847	Nipple	Nodal status		Intraoperative pathological measurement	≤20, 20~50, >50; continuous	49.82%

Note: ^aNodal positivity not applicable because the studies included ductal carcinoma in situ.

Abbreviations: NA, not available; ER, estrogen receptor.

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