A New and Simple Predictive Formula for Non-Sentinel Lymph Node Metastasis in Breast Cancer Patients with Positive Sentinel Lymph Nodes, and Validation of 3 Different Nomograms in Turkish Breast Cancer Patients

Abstract

Background: Nomogram accuracies for predicting non-sentinel lymph node (SLN) involvement vary between different patient populations. Our aim is to put these nomograms to test on our patient population and determine our individual predictive parameters affecting SLN and non-SLN involvement. Patients and Methods: Data from 932 patients was analyzed. Nomogram values were calculated for each patient utilizing MSKCC, Tenon, and MHDF models. Moreover, using our own patient- and tumor-depended parameters, we established a unique predictivity formula for SLN and non-SLN involvement. Results: The calculated area under the curve (AUC) values for MSKCC, Tenon, and MHDF models were 0.727 (95% confidence interval (CI) 0.64–0.8), 0.665 (95% CI 0.59–0.73), and 0.696 (95% CI 0.59–0.79), respectively. Cerb-2 positivity (p = 0.004) and size of the metastasis in the lymph node (p = 0.006) were found to correlate with non-SLN involvement in our study group. The AUC value of the predictivity formula established using these parameters was 0.722 (95% CI 0.63–0.81). Conclusion: The most accurate nomogram for our patient group was the MSKCC nomogram. Our unique predictivity formula proved to be as equally effective and competent as the MSKCC nomogram. However, similar to other nomograms, our predictivity formula requires future validation studies.

Factors Influencing Non-sentinel Node Metastasis in Patients with Macrometastatic Sentinel Lymph Node Involvement and Validation of Three Commonly Used Nomograms

“…Öz et al (25) reported that Ki-67 and c-erb-B2 expression is connected with non-sentinel metastasis and also two other studies stated cerb-B2 as an independent factor (23,24). We found no direct relation between Ki-67, c-erb-B2, hormone receptor status and non-sentinel involvement.…”

Pathological Examination of Sentinel Lymph Node Biopsy

“…Hilusdaki yağlı değişiklikler tanımlanır. Hilusdan geçen ilk kesitlerde makroskopik görünür metastaz yok ise 3-4 mm'den kalın olan lenf düğümleri olabildiğince ince 2 mm'yi (2000 µm) geçmeyen aralar ile yine uzun eksene paralel dilimlenir, dikkatlice incelenir (3,4,11,28,29,30,31,32,33). Çoğunlukla hilusda yağlı değişiklikler geniş yer kaplar, frozen kesit için de sorun yaratacağından bu alan kortikal grimsi alandan kesilerek ayrılır (Resim 3).…”

“…Kesit aralıkları merkezlere göre 10, 50, 100, 150, 200, 250, 500 μm arasında değişmektedir (3,5,11,28,33).…”

“…En sık kullanılan pansitokeratin "AE1/AE3" dür (3,5,33). AE1/AE3 kullanılmasının CAM 5,2 den daha uygun olduğu belirtilmektedir (45).…”

“…Meme kanseri ve pozitif SLD olan hastalarda, primer tümör boyutu, peritümöral lenfovasküler invazyon yanısıra SLD'deki metastazın boyutu, metastazların anatomik yerleşimi (subkapsüler, parankimal ya da ikisi birlikte), metastatik SLD sayısı, perikapsüler invazyon, çıkarılan SLD'nin sayısının, NSLD tutulumu açısından önemli bulgular içinde yer aldığı belirtilmektedir (52 (13,32,33,45,52). Bunlar da NSLD'nin durumunu %100 doğrulukla belirlememektedir (33).…”