Top

Published in:

01-09-2011 | Original Article

Comparison of two models for predicting non-sentinel lymph node metastases in sentinel lymph node-positive breast cancer patients

Authors: Giovanni D’Eredita’, Vito Leopoldo Troilo, Fernando Fischetti, Giuseppe Rubini, Tommaso Berardi

Published in: Updates in Surgery | Issue 3/2011

Abstract

Several models for the prediction of non-sentinel lymph node (SLN) metastasis in SLN-positive breast cancer patients have been proposed. In this study, the authors evaluate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and an axilla scoring system from Tenon Hospital to predict the probability of having non-(SLN) involvement and to define their actual usefulness when applied to the subgroup of patients with micrometastasis in SLN. The study population consisted of 103 patients: 74 with macrometastasis and 29 with micrometastasis in the SLN. The receiver operating characteristic (ROC) curves were drawn and the area under the curves (AUCs) was calculated to assess the discriminative power of the nomograms. Both the ROCs and relative AUCs were calculated for all the patients in the study and for the two subgroups. The AUC for the entire study population was 0.712 in the MSKCC nomogram and 0.759 in the Tenon score. In 74 patients with macrometastasis in SLN, the AUC was 0.760 in MSKCC nomogram and 0.707 in Tenon score. Micrometastasis in SLN was found in t29 patients: AUC was 0.577 in the MSKCC nomogram and 0.738 in the Tenon score. Several institutions have tested the MSKCC nomogram, with AUC ranging from 0.58 to 0.84. It was not validated by four studies, which did not recommend its use in patients with micrometastasis. In our results, the validation of the Tenon score confirmed its relevance even in patients with micrometastasis in SLN.

Giuliano AE, Haigh PI, Brennan MD et al (2000) Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 18:2553–2559PubMed

Veronesi U, Paganelli G, Galimberti V et al (1997) Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 349:1864–1867PubMedCrossRef

Bolster MJ, Peer PG, Bult P et al (2007) Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study. Ann Surg Oncol 14:181–189PubMedCrossRef

Zavagno G, De Salvo GL, Bozza F et al (2004) Number of metastatic sentinel nodes as predictor of axillary involvement in patients with breast cancer. Breast Cancer Res Treat 86:171–179PubMedCrossRef

Nos C, Harding C, Freneaux P et al (2003) Predicting of tumour in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastases. Br J Surg 90 11:1354–1360CrossRef

Cady B (1997) Guest Editorial, case against axillary lymphadenectomy for most patients with infiltrating breast cancer. J Surg Oncol 66:7–10PubMedCrossRef

Changsri C, Prakash S, Sandweiss L et al (2004) Prediction of additional axillary metastasis of breast cancer following sentinel lymph node surgery. Breast J 10:392–397PubMedCrossRef

Cserni G (2001) Sentinel lymph-node biopsy-based prediction of further breast cancer metastases in the axilla. Eur J Surg Oncol 27:532–538PubMedCrossRef

Viale G, Maiorano E, Pruneri G et al (2005) Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg 241:319–325PubMedCrossRef

10.

Wada N, Imoto S, Yamauchi C et al (2006) Predictors of tumour involvement in remaining axillary lymph nodes of breast cancer patients with positive sentinel lymph node. Eur J Surg Oncol 32:29–33PubMedCrossRef

11.

Farshid G, Pradhan M, Kollias J et al (2004) A decision aid for predicting non-sentinel node involvement in women with breast cancer and at least one positive sentinel node. The Breast 13:494–501PubMedCrossRef

12.

Tan YY, Fan YG, Lu Y et al (2005) Ratio of positive to total number of sentinel nodes predicts non sentinel node status in breast cancer patients. Breast J 11:248–253PubMedCrossRef

13.

Turner RR, Chu KU, Qi K et al (2000) Pathologic features associated with non-sentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer 89:574–581PubMedCrossRef

14.

Wong SL, Edwards MJ, Chao C et al (2001) Predicting the status of the non-sentinel axillary nodes. Arch Surg 136:563–568PubMedCrossRef

15.

Guenther JM, Hansen NM, DeFronzo LA et al (2003) Axillary dissection is not required for all patients with breast cancer and positive nodes. Arch Surg 138:52–56PubMedCrossRef

16.

Schrenk P, Konstantiniuk P, Wolfl S et al (2005) Prediction of non- sentinel lymph node status in breast cancer with a micrometastatic sentinel node. Br J Surg 92:707–713PubMedCrossRef

17.

Van Zee KJ, Manasseh DM, Bevilacqua JL et al (2003) A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10:1140–1151PubMedCrossRef

18.

Barranger E, Coutant C, Flahault A et al (2005) An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat 91:113–119PubMedCrossRef

19.

Pal A, Provenzano E, Duffy SW et al (2008) A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive. Br J Surg 95:302–309PubMedCrossRef

20.

Kohrt HE, Olshen RA, Bermas HR et al (2008) New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer 8:66PubMedCrossRef

21.

D’Eredità G, Ferrarese F, Cecere V et al (2003) Subareolar injection may be more accurate than other techniques for sentinel lymph node biopsy in breast cancer. Ann Surg Oncol 10:942–947PubMedCrossRef

22.

D’Eredità G, Giardina C, Guerrieri AM et al (2006) A further validation of subareolar injection technique for sentinel lymph node biopsy. Ann Surg Oncol 13:701–707PubMedCrossRef

23.

D’Eredità G, Troilo VL, Giardina C et al (2006) L’iniezione subareolare per la biopsia del linfonodo sentinella nei tumori multipli della mammella. G Chir 27:436–441PubMed

24.

Kern KA (1999) Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye. J Am Coll Surg 189:539–545PubMedCrossRef

25.

Viale G, Maiorano E, Mazzarol G et al (2001) Histologic detection and clinical implications of micrometastases in axillary lymph nodes for patients with breast carcinoma. Cancer 92:1378–1384PubMedCrossRef

26.

Coutant C, Rouzier R, Fondrinier E et al (2009) Validation of the Tenon breast cancer score for predicting non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis: a prospective multicenter study. Breast Cancer Res Treat 113:537–543PubMedCrossRef

27.

Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiving operating characteristic curves derived from the same cases. Radiology 148:839–843PubMed

28.

Alran S, De Rycke Y, Fourchotte V et al (2007) Validation and limitations of use of a breast cancer nomogram predicting the likelihood of nonsentinel node involvement after positive sentinel node biopsy. Ann Surg Oncol 14:2195–2201PubMedCrossRef

29.

Kocsis L, Svebis M, Boross G et al (2004) Use and limitations of a nomogram predicting the likelihood of non-sentinel node involvement after a positive sentinel node biopsy in breast cancer patients. Am Surg 70:1019–1024PubMed

30.

Soni NK, Carmalt HL, Gillett DJ et al (2005) Evaluation of a breast cancer nomogram for prediction of non-sentinel lymph node positivity. Eur J Surg Oncol 31:958–964PubMedCrossRef

31.

Smidt ML, Kuster DM, van der Wilt GJ et al (2005) Can the Memorial Sloan-Kettering Cancer Center nomogram predict the likelihood of nonsentinel lymph node metastases in breast cancer patients in the Netherlands? Ann Surg Oncol 12:1066–1072PubMedCrossRef

32.

Degnim AC, Reynolds C, Pantvaidya G et al (2005) Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram. Am J Surg 190:543–550PubMedCrossRef

33.

Lambert LA, Ayers GD, Hwang RF et al (2006) Validation of a breast cancer nomogram for predicting nonsentinel lymph node metastasis after a positive sentinel node biopsy. Ann Surg Oncol 13:310–320PubMedCrossRef

34.

Cripe MH, Beran LC, Liang WC et al (2006) The likelihood of additional nodal disease following a positive sentinel lymph node biopsy in breast cancer patients: validation of a nomogram. Am J Surg 192:484–487PubMedCrossRef

35.

Dauphine CE, Haukoos JS, Vargas MP et al (2007) Evaluation of three scoring systems predicting non sentinel node metastasis in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 14:1014–1019PubMedCrossRef

36.

Ponzone R, Maggiorotto F, Mariani L et al (2007) Comparison of two models for the prediction of nonsentinel node metastasis in breast cancer. Am J Surg 193:686–692PubMedCrossRef

37.

Bevilacqua JL, Kattan MW, Fey JV et al (2007) Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol 25:3670–3679PubMedCrossRef

38.

van la Parra RF, Ernst MF, Bevilacqua JL et al (2009)Validation of a nomogram to predict the risk of nonsentinel lymph node metastases in breast cancer patients with a positive sentinel node biopsy: validation of the MSKCC breast nomogram. Ann Surg Oncol 16:1128–1135

39.

Klar M, Jochmann A, Foeldi M, Stumpf M et al (2008) The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population. Breast Cancer Res Treat 112:523–531PubMedCrossRef

40.

Gur AS, Unal B, Johnson R et al (2009) Predictive probability of four different breast cancer nomograms for nonsentinel axillary lymph node metastasis in positive sentinel node biopsy. J Am Coll Surg 208:229–235PubMedCrossRef

41.

Hwang RF, Krishnamurthy S, Hunt KK et al (2003) Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer. Ann Surg Oncol 10:248–254PubMedCrossRef

42.

Coutant C, Olivier C, Lambaudie E et al (2009) Comparison of models to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a prospective multicenter study. J Clin Oncol 27:2800–2808PubMedCrossRef

43.

D’Eredità G, Troilo VL, Giardina C et al (2010) Sentinel lymph node micrometastasis and risk of non-sentinel lymph node metastasis: validation of two breast cancer nomograms. Clin Breast Cancer 10:445–451PubMedCrossRef

44.

Goyal A, Newcombe RG, Chhabra A et al (2006) Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat 99:203–208PubMedCrossRef

45.

Martin RC, Chagpar A, Scoggins CR et al (2005) Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg 241:1005–1012PubMedCrossRef

46.

Wong SL, Edwards MJ, Chao C et al (2001) Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate. J Am Coll Surg 192:684–689PubMedCrossRef

47.

Reed J, Rosman M, Verbanac KM et al (2009) Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/AnnArundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 208:333–340PubMedCrossRef

48.

Calhoun KE, Hansen NM, Turner RR et al (2005) Non sentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node: implications for completion axillary node dissection. Am J Surg 190:588–591PubMedCrossRef

49.

van Rijk MC, Peterse JL, Nieweg OE et al (2006) Additional axillary metastases and stage migration in breast cancer patients with micrometastases or submicrometastases in sentinel lymph nodes. Cancer 107:467–471PubMedCrossRef

Title: Comparison of two models for predicting non-sentinel lymph node metastases in sentinel lymph node-positive breast cancer patients
Authors: Giovanni D’Eredita’
Vito Leopoldo Troilo
Fernando Fischetti
Giuseppe Rubini
Tommaso Berardi
Publication date: 01-09-2011
Publisher: Springer Milan
Published in: Updates in Surgery / Issue 3/2011
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-011-0079-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of two models for predicting non-sentinel lymph node metastases in sentinel lymph node-positive breast cancer patients

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2011

Should esophageal resections for cancer be performed in high-volume centers only?

Plication of the right atrium in order to confront a right coronary artery under tension graft

Chest wall metastasis from oesophageal adenocarcinoma: a rare presentation

Letter from the Editors-in-Chief

A retrospective analysis of delayed complications of urethroplasty at a tertiary care centre

Erratum to: Rare abdominal metastases from occult lobular breast cancer: report of two cases