Predicting axillary lymph node metastases in breast carcinoma patients

Abstract

Routine axillary dissection is primarily used as a means of assessing prognosis to establish appropriate treatment plans for patients with primary breast carcinoma. However, axillary dissection offers no therapeutic benefit to node negative patients and patients may incur unnecessary morbidity, including mild to severe impairment of arm motion and lymphedema, as a result. This paper outlines a method of evaluating the probability of harbouring lymph node metastases at the time of initial surgery by assessment of tumour based parameters, in order to provide an objective basis for further selection of patients for treatment or investigation. The novel aspect of this study is the use of Maximum Entropy Estimation (MEE) to construct probabilistic models of the relationship between the risk factors and the outcome. Two hundred and seventeen patients with invasive breast carcinoma were studied. Surgical treatment included axillary clearance in all cases, so that the pathologic status of the nodes was known. Tumour size was found to be significantly correlated (P < 0.001) to the axillary lymph node status in the multivariate anlaysis with age (P = 0.089) and vascular invasion (P = 0.08) marginally correlated. Using the multivariate model constructed, 38 patients were predicted to have risk of nodal metastases lower than 20%, of these only 4 (10%) patients had lymph node metastases. A comparison with the Multivariate Logistic Regression (MLR) was carried out. It was found that the predictive quality of the MEE model was better than that of the MLR model. In view of the small sample size, further verification of this model is required in assessing its practical application to a larger population.

Lymphatic Invasion, Tumor Size, and Age Are Independent Predictors of Axillary Lymph Node Metastases in Women With T1 Breast Cancers

“…In addition to identifying patients at low risk of axillary metastases, we should identify characteristics of primary tumors predictive of lymph node involvement. 4,5,7,10,14 In these patients, a limited ALND or sentinel lymph node biopsy may have a high false-negative rate. Recent enthusiasm for limiting the extent of removal of axillary lymph nodes increases the likelihood that nodal metastases will be missed.…”

Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN

“…Two studies were excluded because the full text was not available [52;53]. Seventeen studies only presented predictive factors for positive axillary lymph nodes (SLN biopsy was not performed) [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69].…”

“…Potentially appropriate references to be included in review, n= 64 Predictive factors in SLN micromets, n= 7 excluded [5,[75][76][77][78][79][80] References retrieved for more detailed evaluation, n= 85 Predictive factors for ≥ 4 positive axillary nodes, n= 6 excluded [69][70][71][72][73][74] No SLN performed, only predictive factors of positive ALND, n= 17 excluded [4,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] References with usable information, n= 56 -SNB performed -completion ALND in SLN+ cases -data on predictive factors for positive NSN Meta-analysis, n= 1 excluded [87] No raw data, n= 4 excluded [13,20,81,82] Overlap of data between studies, n= 5 excluded [11,22,23,88,89] SLN positive with CK-IHC only, n= 2 excluded [83][84] Only tumours < 15 mm, n= 1 excluded [86] Only special types of breast cancer, n=1 excluded …”

Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution

“…The identification of reliable clinicopathologic predictors of the risk for SLN metastases would be effective in selecting patients for SLNB and sparing axillary lymph node surgery to those at the lowest risk of axillary lymph node involvement. Possible clinicopathologic predictors of axillary lymph node involvement in patients with breast carcinoma were studied quite extensively in the pre‐SLNB era, with the identification of primary tumor palpability,9–11 size,6, 11–21 type10, 13 and grade,11–13 lymphovascular invasion,6, 10–12, 14, 16, 20, 21 receptor status,13, 22 young age,13, 14 and multifocality23 as features independently correlated with axillary lymph node metastases. None of these features, however—alone or combined with others in predictive models—has attained enough strength to be adopted for the selection of patients for whom completion of ALND may be avoided.…”