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

Güven, Hikmet Erhan; Doğan, Lütfi; Kültüroğlu, Mahmut Onur; Gülçelik, Mehmet Ali; Özaslan, Cihangir

doi:10.5152/ejbh.2017.3545

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…Overall, MDA showed the best performance in all parameters evaluated among the three nomograms analysed. These results are in line with other studies comparing various nomograms . However, this model is only applicable for patients with tumours up to 3 cm in size.…”

Section: Discussionsupporting

confidence: 90%

“…The aim of this study is to identify risk factors and validate three nomograms to estimate the likelihood of non‐sentinel lymph node (NSLN) metastasis using data from 13 years of breast cancer surgery from two tertiary hospitals in Australia. These nomograms (MD Anderson Cancer Center (MDA), Helsinki University Hospital and Memorial Sloan Kettering Cancer Centre (MSKCC)) have been widely validated and are available as online calculators. Although the MSKCC nomogram has been previously validated in a cohort of Australian patients, to the author's knowledge, there are no other studies in Australia evaluating the applicability of this or other related nomograms, especially after the publication of the Z0011 study.…”

Section: Introductionmentioning

confidence: 99%

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Predicting non‐sentinel lymph node metastasis in Australian breast cancer patients: are the nomograms still useful in the post‐Z0011 era?

Tapia

Ying

et al. 2019

ANZ Journal of Surgery

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Key words breast cancer, external validation, nomogram, nonsentinel lymph node metastasis, sentinel lymph node biopsy. Correspondence AbstractBackground: Axillary lymph node dissection (ALND) can be avoided in breast cancer patients with low-volume disease in the sentinel lymph nodes (SLNs) according to Z0011 trial. We believe that nomograms developed for predicting non-sentinel lymph node (NSLN) metastases can guide the axillary treatment in patients who do not fully match the criteria of Z0011 study. We identified risk factors and evaluated the performance of three nomograms to predict NSLN status in patients with positive SLNs. Methods: Data from 526 breast cancer patients with positive SLNs who underwent ALND at two Australian hospitals from 2002 to 2015 were studied. Univariate and multivariate associations for NSLN metastasis were analysed. Predictive models evaluated were MD Anderson Cancer Centre (MDA), Helsinki University Hospital and Memorial Sloan Kettering Cancer Centre. Results: Thirty-nine per cent of patients demonstrated NSLN metastasis. The multivariate analysis identified extranodal extension (OR 3.2, 95% CI 2.07-4.80), tumour size >2 cm (OR 2.5, 95% CI 1.66-3.89), macrometastasis (OR 1.9, 95% CI 1.09-3.47), positive SLN ratio >0.5 (OR 1.7, 95% CI 1.16-2.60) and lymphovascular invasion (OR 1.6, 95% CI 1.09-2.44) as independent predictors for NSLN metastasis. MDA nomogram showed the best discrimination (area under the curve of 0.74) and a 9% false negative rate for predicted probability of NSLN metastasis ≤10%. Conclusion: Our results suggest that presence of extranodal extension and tumour size >2 cm may influence the need of further axillary treatment. Conversely, ALND can be safety spared in low risk patients identified by MDA nomogram.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Predicting non‐sentinel lymph node metastasis in Australian breast cancer patients: are the nomograms still useful in the post‐Z0011 era?

Tapia

Ying

et al. 2019

ANZ Journal of Surgery

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“…In patients with metastasis on SLNB, residual non-sentinel node metastases could be left in the axilla inmany patients, and this is expected to be higher in patients with macrometastases on the SLNB than in micrometastasis on SLNB (77,78). That residual disease left in the axilla could be responsible for axillary recurrence is the main argument for performing ALND or axillary radiotherapy in SLNB-positive patients, especially in patients with macrometastases on SLNB.…”

Section: Axillary Treatment In Patients With Metastasis On Sentinel Lmentioning

confidence: 99%

The Adventure of Axillary Treatment in Early Stage Breast Cancer

Kuru

2020

Eur J Breast Health

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Axillary lymph node dissection (ALND) which was an essential part of breast cancer treatment and the gold standard in evaluation of the status of axillary lymph node had notorious with increased arm morbidity and reduction of quality of life. Sentinel lymph node biopsy (SLNB) accurately stages the axilla in early breast cancer and ALND is omitted in SLNB negative patients. In patients with positive SLNB the omission of ALND with or without replacement of axillary radiotherapy has also been recommended by guidelines. The neoadjuvant chemotherapy (NAC) which has been increasingly used for large breast cancers to downstage the tumours for allowing breast conserving surgery and decreasing mastectomy rate has also been used in axillary node positive patients to reduce the need for ALND. The issues surrounding the treatment of axilla in patients treated with NAC; application and false negative rate of SLNB, number of identified sentinel lymph nodes, and axillary radiotherapy instead of ALND are currently the discussed and practiced hot topics. The quests for decreasing arm morbidity without compromising outcome in breast cancer treatment which have begun with the invention of SLNB continue for axilla conserving surgery. This article reviews the adventure of axillary treatment in breast cancer patients treated with or without NAC.

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“…The conundrum of further axillary intervention after a macrometastatic‐positive SNB needs to be definitively settled . Ultimate predictive variables in our study were the number of positive SNs and the presence of extracapsular extension in SNs, also in agreement with another independent report . SN ECE is seemingly related to an increased tumor invasive potential and is associated with a greater chance of HTB.…”

Section: Multivariate Regression Analysis For High Tumor Burden (Htb)mentioning

confidence: 99%

A regression model to predict axillary high tumor burden in sentinel node‐positive breast cancer patients

et al. 2019

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

Cited by 8 publications

References 29 publications

Predicting non‐sentinel lymph node metastasis in Australian breast cancer patients: are the nomograms still useful in the post‐Z0011 era?

Predicting non‐sentinel lymph node metastasis in Australian breast cancer patients: are the nomograms still useful in the post‐Z0011 era?

The Adventure of Axillary Treatment in Early Stage Breast Cancer

A regression model to predict axillary high tumor burden in sentinel node‐positive breast cancer patients

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