Abstract PD2-01: Ultrasound together with clinical indexes cannot predict sentinel lymph node metastasis for ultrasound-axillary lymph node-negative breast cancer patients

Abstract

Background: Sentinel lymph node (SLN) pathology result is crucial to predict axillary lymph nodes (ALN) metastasis as well as to determine systemic treatment strategy. Ultrasound has been paid great attention to the evaluation of ALN metastasis. Whether the combination of known clinic-pathological indexes to ultrasound could predict SLN metastasis for ultrasound-ALN-negative breast cancer, and ultimately achieve the goal of avoiding the invasive method of sentinel lymph node biopsy (SLNB), is the current focus. Objective: To discuss the possibility of predicting SLN metastasis using axillary ultrasonography in combination with patients' clinic-pathologic factors by retrospectively analyzing our institution's large cohort of ultrasound-ALN-negative breast cancer patients' data. Method: This study collected consecutive data from the prospective database of Breast Center of Beijing Cancer Hospital from Oct. 2010 to Apr. 2016. Inclusion criteria: Pathologically diagnosed as primary breast cancer by core needle biopsy (CNB); negative ALN by ultrasound (no ALN detected, or the cortex thickness was even and <3mm); no treatment prior to SLNB. The SLN pathological outcomes were correlated with known clinic-pathologic parameters. Univariate analysis was performed by Chi-Square test, with p<0.05 considered as statistically significant difference. Logistic regression analysis was used for the multivariate analysis, the area under curve >0.75 stands for acceptable predicting accuracy. Results: Non-selective consecutive data with a total of 4,936 primary breast cancer cases treated from Oct. 2010 to Apr. 2016 was extracted from the prospective database. Exclusion criteria: Pathologically diagnosed by surgical resection (n=492); carcinoma in situ (n=145); abnormal ALN by ultrasound underwent fine needle aspiration (FNA) or CNB (n= 750); systemic treatment prior to SLNB (n=349); no SLN detected after injection (n=81); male (n=4). A total of 3,115 cases met the inclusion criteria. Among which 2,317 (74.3%) cases were negative SLN pathology and 798 (25.7%) cases were positive SLN pathology. The main findings of this study were that the univariate analysis such as, patients' age, menstruation, tumor size, ER/PR, HER-2 were influencial factors, p<0.05. Multivariate analysis showed that the area under the ROC curve was 0.658(95% CI 0.637-0.679), indicating that the combination of all the clinic-pathologic factors with ultrasound could not stand for acceptable predicting accuracy. Conclusion: Ultrasound together with clinical indexes cannot predict SLN metastasis for ultrasound-ALN-negative breast cancer patients. The result of univariates related to SLNItemsSLN-Negative%(n)SLN-Positive%(n)p valueAge≤4070.5(324)29.5(136)0.036>4075.1(1,993)24.9(662)Premenopausal71.8(1,215)28.2(477)<0.001Postmenopausal77.4(1,102)22.6(321)T size(cm)≤278.4(1,242)21.6(342)<0.001T size(cm)>270.2(1,075)29.8(456)IDC I83.0(455)17.0(93)<0.001IDC II+III71.1(1,603)28.8(649)Other pathology types82.2(259)17.8(56)ER≤10%85.8(652)14.2(108)<0.001ER>10%70.7(1,665)29.3(690)PR≤10%80.3(851)19.7(208)<0.001PR>10%71.3(1,466)28.7(590) HER-2 0,1+,2+&FISH-73.1(1,729)26.9(635)0.008HER-2 3+,2++78.3(588)21.7(163) Citation Format: Chen X, He Y, Huo L, Li J, Xie Y, Wang T, Fan Z, Ouyang T. Ultrasound together with clinical indexes cannot predict sentinel lymph node metastasis for ultrasound-axillary lymph node-negative breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-01.