Cancer Res Treat.  2017 Oct;49(4):1088-1096. 10.4143/crt.2016.473.

Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery

Affiliations
  • 1Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
  • 2Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
  • 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. hanw@snu.ac.kr
  • 4Department of Surgery, Seoul St. Mary's Hospital, Seoul, Korea.
  • 5Department of Surgery, Asan Medical Center, Seoul, Korea.
  • 6Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 7Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
The American College of Surgeons Oncology Group Z0011 trial reported that complete dissection of axillary lymph nodes (ALNs) may not be warranted in women with clinical T1-T2 tumors and one or two involved ALNs who were undergoing lumpectomy plus radiation followed by systemic therapy. The present study was conducted to identify preoperative imaging predictors of ≥ 3 ALNs.
MATERIALS AND METHODS
The training set consisted of 1,917 patients with clinical T1-T2 and node negative invasive breast cancer. Factors associated with ≥ 3 involved ALNs were evaluated by logistic regression analysis. The validation set consisted of 378 independent patients. The nomogram was applied prospectively to 512 patients who met the Z0011 criteria.
RESULTS
Of the 1,917 patients, 204 (10.6%) had ≥ 3 positive nodes. Multivariate analysis showed that involvement of ≥ 3 nodes was significantly associated with ultrasonographic and chest computed tomography findings of suspicious ALNs (p < 0.001 each). These two imaging criteria, plus patient age, were used to develop a nomogram calculating the probability of involvement of ≥ 3 ALNs. The areas under the receiver operating characteristic curve of the nomogram were 0.852 (95% confidence interval [CI], 0.820 to 0.883) for the training set and 0.896 (95% CI, 0.836 to 0.957) for the validation set. Prospective application of the nomogram showed that 60 of 512 patients (11.7%) had scores above the cut-off. Application of the nomogram reduced operation time and cost, with a very low re-operation rate (1.6%).
CONCLUSION
Patients likely to have ≥ 3 positive ALNs could be identified by preoperative imaging. The nomogram was helpful in selective intraoperative examination of sentinel lymph nodes.

Keyword

Sentinel lymph node; Nomograms; Z0011; Breast neoplasms; Chest; Computed tomography; Axilla sonography

MeSH Terms

Breast Neoplasms*
Breast*
Female
Humans
Logistic Models
Lymph Nodes*
Mastectomy, Segmental
Multivariate Analysis
Nomograms*
Prospective Studies
ROC Curve
Surgeons
Thorax

Figure

  • Fig. 1. Nomogram for predicting the probability of having three or more involved axillary lymph node (ALNs). US, ultrasonography; CT, computed tomography.

  • Fig. 2. Performance of the nomogram in the training set and the validation set were each measured using the area under the receiver operating characteristic curves. (A) Training set: 0.852 (95% confidence level, 0.820 to 0.883). (B) Validation set: 0.896 (95% confidence level, 0.836 to 0.957).

  • Fig. 3. Calibration plot of the nomogram using validation cohort.


Cited by  1 articles

Clinical Value of Axillary Ultrasonography in Breast Cancer with Lymph Node Metastases
Jung Ho Park, Hyun Ryung Kim, Sanghwa Kim, Young Ah Lim, Kyoonsoon Jung, Lee Su Kim
J Surg Ultrasound. 2021;8(2):41-47.    doi: 10.46268/jsu.2021.8.2.41.


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