Article Text

Download PDFPDF
The prognostic significance of early stage lymph node positivity in operable invasive breast carcinoma: number or stage
  1. Emad A Rakha1,
  2. David Morgan2,
  3. Douglas Macmillan3
  1. 1Department of Histopathology, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
  2. 2Department of Oncology, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3Department of Surgery, The Breast Unit, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
  1. Correspondence to Dr Emad A Rakha, Molecular Medical Sciences, University of Nottingham, Department of Histopathology, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; emadrakha{at}


Aim The earlier detection of breast cancer through mammographic screening has resulted in a shift in stage distribution with patients who are node-positive tending to present with a lower number of positive lymph nodes (LN). This study aims to assess the prognostic value of absolute number of positive nodes in the pN1 TNM stage (1–3 positive LN) and whether the prognostic value of the number of nodes in this clinically important stage justifies its consideration in management decisions.

Methods This study is based on a large and well-characterised consecutive series of operable breast cancer (3491 cases), treated according to standard protocols in a single institution, with a long-term follow-up.

Results LN stages and the absolute number of LN are associated with both breast cancer specific survival (BCSS) and distant metastasis free survival (DMFS). In the pN1 stage, patients with three positive LN (14% of pN1) show shorter BCSS (HR=1.9, (95% CI 1.3 to 2.6)) and shorter DMFS (HR=2.2, (95% CI 1.6 to 2.9)) when compared with one and/or two positive nodes. This effect is noted in the whole series as well as in different subgroups based on tumour size (pT1c and pT2), histological grade (grade 2 and 3), vascular invasion and oestrogen receptor status (both positive and negative). Multivariable analyses showed that three positive LN, compared with one and two positive LN, are an independent predictor of shorter BCSS and DMFS.

Conclusion The number of LN in the pN1 stage yielded potentially informative risk assignments with three positive LN providing an independent predictor of poorer outcome.

  • Invasive breast carcinoma
  • nodal status
  • lymph node number and nodal stage
  • prognosis and outcome
  • breast
  • genetics
  • oncology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Nottingham Research Ethics Committee 2 under the title ‘Development of a molecular genetic classification of breast cancer’.

  • Provenance and peer review Not commissioned; externally peer reviewed.