A scoring system to predict nonsentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes: a comparison with other scoring systems.
BACKGROUND
The majority of breast cancer patients with metastatic sentinel lymph node (SLN) do not harbor additional metastasis in non-SLN. It is unclear which patients with metastatic SLN require axillary lymph node dissection (ALND). The aim of this study was to identify predictive factors of non-SLN metastasis and to develop a scoring system.


METHODS
The training dataset consisted of 184 breast cancer patients. The independent validation dataset consisted of 82 breast cancer patients. The receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems.


RESULTS
Multivariate analysis revealed that non-SLN status was predicted by preoperative ultrasonographic findings of the axilla, lymphovascular invasion, increasing tumor size, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Based on multivariate logistic regression, we developed a scoring system for predicting non-SLN metastasis. The AUC for our scoring system was superior to other published scoring systems when identical validation data were applied.


CONCLUSIONS
The likelihood of metastatic non-SLN correlated with preoperative ultrasonographic findings of the axilla, increasing pathologic size of the primary tumor, presence of lymphovascular invasion, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Our scoring system appears to be effective and accurate for selecting patients for whom ALND can be avoided.
Department of Surgery, Keimyung University College of Medicine, Dongsan Medical Center, Daegu 700-712, Korea.
Jihyoung
J
Cho
Wonshik
W
Han
Jong Won
JW
Lee
Eunyoung
E
Ko
So Young
SY
Kang
So-Youn
SY
Jung
Eun-Kyu
EK
Kim
Woo Kyung
WK
Moon
Nariya
N
Cho
In-Ae
IA
Park
Jun-Key
JK
Chung
Ki-Tae
KT
Hwang
Sung-Won
SW
Kim
Dong-Young
DY
Noh
D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy