Clinical Studyfor Risk Factors Of Nipple And Skin Invasion And Metastatic Pattern Of Axillary Lymph Nodes In Breast Cancer

Objective:With the development of society, people are pursuing more beautiful appearances. The extent of surgery has narrowed down, and the requirements of the preservation of nipple, skin and axillary lymph nodes has increased. The aim of this study was to evaluate the risk factors of nipple and skin invasion, and metastatic pattern of axillary lymph nodes, in order to offer theoretical foundations for surgical options and oncological safety.Methods:Our study included three parts:In Part Ⅰ,we analyzed the risk factors of nipple invasion in breast cancer. We studied521patients with breast cancer. Nipple invasion cases were recorded and factors including general clinical and pathological characteristics were taken into consideration. Associations between those factors and nipple invasion were investigated. Univariate analyses were performed by chi-square test or Student’s t test or non-parametric test and multivariate analyses by stepwise Logistic regression. Binary regression model was developed.In Part Ⅱ,we analyzed the risk factors of skin invasion in breast cancer. We studied521patients with breast cancer. Skin invasion cases were recorded and factors including general clinical and pathological characteristics were taken into consideration. Associations between those factors and skin invasion were investigated. Statistical method was the same as that in the first part.In PartIII,we studied the metastatic pattern of axillary lymph nodes. A total of104patients with breast cancer that axillary lymph nodes were separated into different groups during the operation enter the research. The number of total and positive lymph nodes of different groups were recorded and factors including general clinical and pathological characteristics were taken into consideration. The role of axillary lymph nodes metastasis and the related risk factors were investigated. Statistical method was the same as that in the first part.Results:Part Ⅰ:Risk factors of nipple invasion in breast cancer.In the total521cases, nipple invasion was found in18patients (3.5%). The incidence of nipple invasion was related with tumor size, TAD, nipple retraction, blood discharge, axillary lymph nodes metastasis, ki67<14%. And nipple retraction, blood discharge, axillary lymph nodes metastasis and ki67<14%were independent risk factors of nipple invasion.Part Ⅱ:Risk factors of skin invasion in breast cancer.In the total521cases, skin invasion was found in5patients (1%). The incidence of skin invasion was related with tumor size, histological grade, skin fixed and the number of positive lymph nodes. Skin fixed was the independent risk factors of skin invasion. PartⅢ:Study of metastatic pattern of axillary lymph nodes.In the total of104cases,47had positive lymph nodes. The positive rate descend from group Ⅰ to groupⅢ."Skip metastasis" were found in6patients (5.8%). Axillary lymph nodes was related with tumor size, tumor number, blood signal inside the tumor, HER2overexpression, ki67>14%. The incidence of "skip metastasis" was related with tumor number, blood signal inside the tumor, palpation of axillary lymph nodes. The number of tumor≥2was the independent risk factor of "skip metastasis". The metastasis rate of level Ⅲnodes was7.7%, and it was related with tumor number, tumor size, level Ⅰ and Ⅱ lymph nodes metastasis and the number of involved nodes, Rotter lymph nodes metastasis. The rate of Rotter lymph nodes metastasis was6.7%, and it was related with tumor size, metastasis of level Ⅰ, Ⅱ,Ⅲymph nodes, and the number of involved nodes.Conclusion:The incidence of nipple invasion was3.5%, and it is related with tumor size, TAD, nipple retraction, blood discharge, axillary lymph nodes metastasis, ki67<14%. The incidence of skin invasion was1%, and it is related with tumor size, histological grade, skin fixed and the number of positive lymph nodes. The incidence of nipple and skin invasion are both relatively low. For most patients, the preservation procedures is feasible. But for patients with risk factors above, the preservation of nipple and skin is risky.Axillary lymph node metastases is mostly carried out in the order from group Ⅰ to group Ⅱ to groupⅢ, but the "skip metastasis" does exist. The rate of "skip metastasis" and levelⅢmetastasis is very low. For most patients, the preservation of groupⅢ nodes is feasible. But for patients with risk factors above, complete axillary lymph nodes clearance is recommended. The detected rate and metastatic rate of Rotter lymph nodes is very low. But in patients with detectable Rotter lymph nodes, the metastatic rate is38.9%. Therefore, dissection of Rotter lymph nodes is recommended.