title: Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis.
abstract: 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.
authors.affiliation: Department of Surgery, Columbia Presbyterian Comprehensive Breast Center, New York Presbyterian Hospital, NY, USA. kpr2@columbia.edu
authors.forename: Kathie-Ann
authors.initials: KA
authors.lastname: Joseph
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Tamer
authors.forename: Ian
authors.initials: I
authors.lastname: Komenaka
authors.forename: Andrea
authors.initials: A
authors.lastname: Troxel
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Ditkoff
authors.forename: Freya
authors.initials: F
authors.lastname: Schnabel
mesh_terms: 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