Surgical strategy management following lymph nodal positivity at the three levels (a retrospective and perspective study).

The purpose of this study is to evaluate the type of distribution, regular or irregular, of metastases in lymph nodes of I, II and III level. We inted also to establish if the levels of lymph nodal areas represent an evaluation index of prognostic risk more effective than other ones. The results evidenced that in 19.2% of all the classes N+ metastases were not increasing regularly from the level I to the level III. The influence of seven factors on disease free survival has been evaluated: pT, pN, number of metastatic nodes, ER+ or ER-, PgR+ or PgR-, grading, metastatic level at axillary lymph nodes. The present report points out that only the extent of tumor and lymph nodal level have a statistically significant influence on disease free survival. Comparison among disease free survival curves stage N0 with N+ at I level and with N+ at II level revealed that there is no significant difference of survival among these classes, while the comparison between the first 3 classes and N+ at III level is statistically significant.