A Nomogram Predicting Lymph Node Metastasis in T1 Breast Cancer based on the Surveillance, Epidemiology, and End Results Program

Zhao, Yanqing; Liu, Yi-Rong; Xie, Shao Wei; Jiang, Yi; Shao, Zhi Ming

doi:10.7150/jca.30386

Cited by 26 publications

(34 citation statements)

References 28 publications

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“…The role of SLNB is controversial. According to the literature, approximately 60% to 85% of early breast cancer cases are node negative, thus would not benefit from SLNB [1,2,5,[22][23][24][25][26]. In our study, 85.0% of the cases were node-negative, and axillary surgical interventions were unnecessary.…”

Section: Discussionmentioning

confidence: 53%

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Rukanskienė¹,

Veikutis²,

Jonaitienė³

et al. 2020

Medicina

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Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50–75% to 15–30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.

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Section: Discussionmentioning

confidence: 53%

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Rukanskienė¹,

Veikutis²,

Jonaitienė³

et al. 2020

Medicina

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“…According to previous studies, an AUC of the ROC curve >0.7 indicated that the built nomogram had a good accuracy and an acceptable discrimination. 16,17 In addition, calibration plots showed that the predicted DM probability was identical to the actual observation. Thus, the built nomogram incorporating clinicopathological characteristics was proved to have an appealing sensitivity and specificity in predicting the risk of DM.…”

Section: Discussionmentioning

confidence: 73%

“…To test the performance of our nomogram, ROC curves were generated in both the training and validation sets. According to previous studies, an AUC of the ROC curve >0.7 indicated that the built nomogram had a good accuracy and an acceptable discrimination 16,17 . In addition, calibration plots showed that the predicted DM probability was identical to the actual observation.…”

Section: Discussionmentioning

confidence: 75%

A clinical model to predict distant metastasis in patients with superficial gastric cancer with negative lymph node metastasis and a survival analysis for patients with metastasis

Chen

Zhang

et al. 2020

Cancer Medicine

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“…For patients with no enlarged lymph nodes in the central compartment before surgery, ultrasound doctors often relax their vigilance in the assessment of lateral lymph nodes and can easily omit to skip metastasis. Previous studies [ 13 , 16 – 18 ] have reported that tumor located in the upper portion and with tumors diameter of no larger than 1 cm were closely linked to skip metastasis, and suggested that patients with the above risk factors should be carefully evaluated for lymph node status. Unfortunately, these studies did not give the probability of skip metastasis in these patients, or what kind of patients needed to undergo prophylactic LLN dissection.…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict skip metastasis in papillary thyroid cancer

2020

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Background: Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients. Patients and methods: A total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 in our hospital were enrolled. Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internally validated. Results: The incidence of skip metastases was 11.6% (44/378). Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342-5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017-1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710-17.060; P < 0.001) were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. The area under the curve (AUC) was 0.806 (95% CI, 0.736-0.876), and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66. Decision curve analysis revealed that the nomogram was clinically useful. Conclusion: Based on the risk factors of skip metastasis, a high-performance nomogram was established, which can provide an individual risk assessment and can guide treatment decisions for patients.

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A Nomogram Predicting Lymph Node Metastasis in T1 Breast Cancer based on the Surveillance, Epidemiology, and End Results Program

Cited by 26 publications

References 28 publications

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

A clinical model to predict distant metastasis in patients with superficial gastric cancer with negative lymph node metastasis and a survival analysis for patients with metastasis

A nomogram to predict skip metastasis in papillary thyroid cancer

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