Format

Send to

Choose Destination
Cancer Res Treat. 2017 Oct;49(4):1088-1096. doi: 10.4143/crt.2016.473. Epub 2017 Jan 25.

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

Author information

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

KEYWORDS:

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

PMID:
28161935
PMCID:
PMC5654155
DOI:
10.4143/crt.2016.473
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Publishing M2Community Icon for PubMed Central
Loading ...
Support Center