Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis.
OBJECTIVE
The presence of nonsentinel lymph node (NSLN) metastasis after having a positive sentinel lymph node dissection finding is associated with tumor size and stage, the presence of lymphovascular invasion, micrometastasis, and extranodal extension.


METHODS
Retrospective case series.


METHODS
University hospital.


METHODS
Four hundred seven consecutive patients at a single institution who underwent sentinel lymph node dissection as part of breast conservation or mastectomy with biopsy-proved cancer.


METHODS
Completion axillary lymph node dissection and definitive therapy.


METHODS
Sentinel node metastasis, NSLN metastasis, tumor size and stage, lymphovacular invasion, micrometastasis, extronodal extension, histological tumor characteristics, and number of sentinel nodes removed.


RESULTS
In a univariate analysis, size of the primary tumor and extranodal extension were associated with having positive NSLN findings. The presence of micrometastasis was associated with negative NSLN findings. When all factors were included in a logistic regression analysis, the significant predictor of NSLN metastasis was extranodal extension (P =.002). Lymphovascular invasion was not associated with positive NSLN findings (P =.11). The number of sentinel nodes removed also had no bearing on the status of the NSLNs (P =.37).


CONCLUSIONS
Although primary tumor size and micrometastases correlate with the status of the NSLNs, extranodal extension is the most important independent predictor of NSLN metastasis. These findings may ultimately spare patients a full axillary lymph node dissection. However, pending results of larger clinical trials, full axillary lymph node dissection is still recommended for patients with sentinel lymph node metastases.
Joseph
Kathie-Ann
KA
Department of Surgery, Columbia Presbyterian Comprehensive Breast Center, New York Presbyterian Hospital, NY, USA. kpr2@columbia.edu
El-Tamer
Mahmoud
M
Komenaka
Ian
I
Troxel
Andrea
A
Ditkoff
Beth Ann
BA
Schnabel
Freya
F
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods