Predictors of Sentinel Lymph Node Metastasis in Postoperatively Upgraded Invasive Breast Carcinoma Patients

Abstract

Sentinel lymph node (SLN) biopsy (SLNB) usually need not be simultaneously performed with breast-conserving surgery (BCS) for patients diagnosed with ductal carcinoma in situ (DCIS) by preoperative core needle biopsy (CNB), but must be performed once there is invasive carcinoma (IC) found postoperatively. This study aimed to investigate the factors contributing to SLN metastasis in underestimated IC patients with an initial diagnosis of DCIS by CNB. We retrospectively reviewed 1240 consecutive cases of DCIS by image-guided CNB from January 2010 to December 2017 and identified 316 underestimated IC cases with SLNB. Data on clinical characteristics, radiologic features, and final pathological findings were examined. Twenty-three patients (7.3%) had SLN metastasis. Multivariate analysis indicated that an IC tumor size > 0.5 cm (odds ratio: 3.11, p = 0.033) and the presence of lymphovascular invasion (odds ratio: 32.85, p < 0.0001) were independent risk predictors of SLN metastasis. In the absence of any predictors, the incidence of positive SLNs was very low (2.6%) in the total population and extremely low (1.3%) in the BCS subgroup. Therefore, omitting SLNB may be an acceptable option for patients who initially underwent BCS without risk predictors on final pathological assessment. Further prospective studies are necessary before clinical application.

Preoperative Dynamic Contrast-Enhanced and Diffusion-Weighted Breast Magnetic Resonance Imaging Findings for Prediction of Lymphovascular Invasion of the Lesions in Node-Negative Invasive Breast Cancer

“…22,23 In previous investigations, the LVI positivity was reported as pointing to a high risk of SLN metastasis. [24][25][26][27] Theoretically, the process that results in nodal metastasis begins with lymphangiogenesis followed by LVI. If LVI accompanying a lesion is detected, LN metastasis should always be suspected.…”

“…In our study, a significant positive correlation was found between LVI and SLN metastasis, which is consistent with the literature data. [24][25][26][27] Preoperative breast MRI is clinically important because of its high sensitivity in evaluating breast lesions. 28,29 It is frequently used today.…”

“…In our study, a significant positive correlation was found between LVI and SLN metastasis, which is consistent with the literature data. 24-27…”

A preoperative nomogram model for the prediction of lymph node metastasis in buccal mucosa cancer

“…It has been reported that several clinical characteristics of cancer patients are associated with LNM, such as age, thickness of the primary tumor, tumor differentiation, and T stage 15–19 . Combining these factors with CT/MRI characteristics would be a potential way to improve the accuracy of predicting LNM.…”

The SOUND Randomized Clinical Trial Results

“…In patients with DCIS, a meta-analysis of 16 studies reported an SLN metastasis rate of 4.9% (153 of 3153). Subsequent large studies have reported rates between 1.9% (23 of 1240) and 7.6% (49 of 649), through 4.4% (127 of 2892) in the largest of such studies. Therefore, SLN metastasis rate in patients with preoperative diagnosis of DCIS is much lower compared with the 13.7% SLN metastasis rate in the SLNB arm of the SOUND trial.…”