A Simple Risk Score to Predict the Presence of Non‐Sentinel Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Node
- 5 December 2013
- journal article
- Published by Wiley in World Journal of Surgery
- Vol. 38 (5), 1070-1076
- https://doi.org/10.1007/s00268-013-2387-9
Abstract
Historically, completion axillary lymph node dissection (cALND) is recommended in sentinel lymph node (SLN)-positive patients. However, the high rate of negative non-sentinel nodes (NSNs) in cALND and the reported low axillary recurrence rates have led to a more conservative approach. A risk score was developed to identify a patient's individual risk for NSN metastases. Data of 182 SLN-positive patients who underwent cALND were used for risk score development. The risk score, consisting of pathological tumor size (≤ 20/>20 mm), lymphovascular invasion (no/yes), extracapsular extension (no/yes), size of metastases (≤ 2/>2 mm), and number of positive SLNs (1/>1), was subsequently validated on an external population (n = 180). The area under the receiver operating characteristic curve was 0.78 (95 % CI 0.71-0.85) in the original population and 0.78 (95 % CI 0.70-0.85) in the validation population. Based on the predicted risk for positive NSNs, three groups were defined: low risk (≤ 20 %), intermediate risk (21-50 %), and high risk (>50 %). In total, 88 patients met the Z0011 inclusion criteria and none of them had a high predicted risk. Of the 199 non-Z0011 patients, 67 (33.7 %) had low risk, 96 (48.2 %) had intermediate risk, and 36 (18.1 %) had high risk. A simple risk score, integrating just five clinicopathological variables, was developed that may assist in individual decision making regarding ALND in SLN-positive patients outside of the Z0011 trial.Keywords
This publication has 19 references indexed in Scilit:
- Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the LiteratureAnnals of Surgical Oncology, 2012
- Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLNEuropean Journal of Surgical Oncology, 2011
- Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node MetastasisJama-Journal Of The American Medical Association, 2011
- Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node MetastasesAnnals of Surgery, 2010
- Ljubljana nomograms for predicting the likelihood of non-sentinel lymph node metastases in breast cancer patients with a positive sentinel lymph nodeBreast Cancer Research and Treatment, 2009
- Predicting Non-Sentinel Lymph Node Status After Positive Sentinel Biopsy in Breast Cancer: What Model Performs the Best in a Czech Population?Pathology and Oncology Research, 2009
- Validation of a Nomogram to Predict the Risk of Nonsentinel Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Node Biopsy: Validation of the MSKCC Breast NomogramAnnals of Surgical Oncology, 2009
- New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patientsBMC Cancer, 2008
- A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positiveBritish Journal of Surgery, 2007
- An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvementBreast Cancer Research and Treatment, 2005