A Nomogram for Predicting the Likelihood of Additional Nodal Metastases in Breast Cancer Patients With a Positive Sentinel Node Biopsy

Zee, Kimberly J. Van; Manasseh, Donna Marie; Bevilacqua, José Luiz Barbosa; Boolbol, Susan K.; Fey, Jane; Tan, Lee K.; Borgen, Patrick I.; Cody, Hiram S.; Kattan, Michael W.

doi:10.1245/aso.2003.03.015

Cited by 753 publications

(580 citation statements)

References 38 publications

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“…No model, including the nomogram of Van Zee, is ideal for providing an estimate of the likelihood of finding additional disease in non-SLNs [6]. However, the size of the SLN is significantly predictive of additional non-SLN metastases and size measurement is therefore essential for staging and management of breast cancer patients [7].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the histological size of the sentinel lymph node metastases using RT–PCR assay: a rapid tool to estimate the risk of non-sentinel lymph node invasion in patients with breast cancer

Veys

Majjaj

Salgado

et al. 2009

Breast Cancer Res Treat

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Results: BLN positivity was reported in 19.6% of the patients for a sensitivity of 89%. BLN specificity (94.5%) and negative predictive value (97.5%) clearly demonstrated its reliability to guide ALND decision. All, except one, residual axillary metastases were found in BLN-positive patients.Considering the 78 patients with SLN positivity or discordant status according to both criteria, the metastases histological size was significantly correlated to the expression level of MG (ρ=0.62) and CK19 (ρ=0.64) genes (p<10E-6). Moreover, ALND status positivity was significantly associated to Ct value of MG (z=2.4; p=0.018) and CK19 (z=3.2; p=0.001).Conclusions: The high intra-operative quality performance of the BLN assay minimizes the need for second surgeries for ALND. Results from this investigational study suggest that markers Ct value may provide, intra-operatively, valuable metastases size data and a risk prediction of additional disease in non-SLNs.3

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Section: Discussionmentioning

confidence: 99%

“…Previous investigations found that the size of the SLN metastasis is significantly predictive of the likelihood of additional, non-SLN metastases [6]. The AJCC Cancer Staging Manual, 6 th edition includes size of the metastasis as a determining factor of stage and therefore of prognosis [7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the histological size of the sentinel lymph node metastases using RT–PCR assay: a rapid tool to estimate the risk of non-sentinel lymph node invasion in patients with breast cancer

Veys

Majjaj

Salgado

et al. 2009

Breast Cancer Res Treat

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“…The probability of additional non-SLN metastasis was calculated using the MSKCC nomogram developed by Van Zee et al for patients with complete pathologic information who fit the nomogram inclusion criteria. 3 Among the 302 patients who received RT, 174 received RT at MSKCC, and 128 received RT at outside institutions. RT volumes were classified as standard tangents, high tangents, comprehensive, or partial breast.…”

Section: Methodsmentioning

confidence: 99%

“…Methods of enhanced pathologic assessment of the SLN node have resulted in the increased detection of small-volume (micrometastases and isolated tumor cells) SLN metastases. 1,2 Nomograms that identify patients at low risk for additional lymph node metastases have guided the selection of patients for SLNB alone, 3 leading to a nationwide decline in the performance of completion axillary dissection (cALND). 1 These trends are reflected at our own institution, where cALND rates between 1998 to 2008 decreased from 85% to 73%.…”

Section: Introductionmentioning

confidence: 99%

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

Setton

Cody

Tan

et al. 2011

Cancer

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BACKGROUND: Randomized data suggest that axillary clearance is not necessary in select, clinically lymph nodenegative women with positive sentinel lymph node (SLN) biopsies (SLNBs) who undergo breast-conserving surgery or receive whole-breast radiotherapy and systemic therapy. The additional value of axillary radiotherapy in these patients is unknown. METHODS: The authors identified 326 patients with positive SLNBs who underwent breast-conserving surgery without axillary lymph node dissection from 1997 to 2009. SLN tumor deposits measured 0.2 mm in 58% of patients, 0.3 to 2.0 mm in 35% of patients, and >2 mm in 7% Patients. Ninety-three percent of patients received adjuvant radiotherapy. Radiation fields were categorized as standard tangents, high tangents, comprehensive (tangents plus supraclavicular), or partial breast to reflect coverage of the axilla. Standard tangents included both prone and supine positions. Regional failure was defined as recurrence in the ipsilateral supraclavicular, axillary, or internal mammary lymph nodes. RESULTS: The median follow-up was 55 months (range, 1-158 months). The 4-year rates of regional control, local control, disease-free survival, and overall survival were 99%, 98%, 95%, and 91%, respectively. Three patients had regional recurrences. Two of those patients received adjuvant radiotherapy with standard supine tangents, and 1 patient did not receive radiotherapy. No regional recurrences occurred among 66 patients who received radiotherapy in the prone position. CONCLUSIONS: Regional control was high (99% at 4 years) in patients who had low-volume SLN disease who did not undergo axillary dissection, regardless of whether the axilla was irradiated. Whole-breast radiation alone, including in the prone position, is sufficient treatment after breast-conserving surgery for select patients with tumor-containing SLNs who omit axillary dissection.

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“…The nomogram from the Sloan-Kettering Cancer Center [2] is based on eight variables: tumour size, type and grade, lymphovascular invasion, multifocality, oestrogen receptor status, method of sentinel lymph node metastasis detection, number of positive sentinel lymph nodes and number of negative sentinel lymph nodes. The other three scores are simpler than this and they use only three parameters.…”

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confidence: 99%

Beware the node: the more we know, the less aggressive we are

Piñero

2009

Clin Transl Oncol

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A Nomogram for Predicting the Likelihood of Additional Nodal Metastases in Breast Cancer Patients With a Positive Sentinel Node Biopsy

Abstract: We have developed a user-friendly nomogram that uses information commonly available to the surgeon to easily and accurately calculate the likelihood of having additional, non-SLN metastases for an individual patient.

Cited by 753 publications

References 38 publications

Evaluation of the histological size of the sentinel lymph node metastases using RT–PCR assay: a rapid tool to estimate the risk of non-sentinel lymph node invasion in patients with breast cancer

Evaluation of the histological size of the sentinel lymph node metastases using RT–PCR assay: a rapid tool to estimate the risk of non-sentinel lymph node invasion in patients with breast cancer

Radiation field design and regional control in sentinel lymph node‐positive breast cancer patients with omission of axillary dissection

Beware the node: the more we know, the less aggressive we are

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