Prediction of non-sentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node.
Completion axillary lymph node dissection (cALND) is the golden standard if breast cancer involves the sentinel lymph node (SLN). However, most non-sentinel lymph nodes (NSLN) are not involved, cALND has a considerable complication rate and does not improve outcome. We here present and validate our predictive model for positive NSLNs in the cALND if the SLN is positive. Consecutive early breast cancer patients from one center undergoing cALND for a positive SLN were included. We assessed demographic and clinicopathological variables for NSLN involvement. Uni- and multivariate analysis was performed. A predictive model was built and validated in two external centers. 21.9% of 470 patients had at least one involved NSLN. In univariate analysis, seven variables were significantly correlated with NSLN involvement: tumor size, grade, lymphovascular invasion (LVI), number of positive and negative SLNs, size of SLN metastasis and intraoperative positive SLN. In multivariate analysis, LVI, number of negative SLNs, size of SLN metastasis and intraoperative positive pathological evaluation were independent predictors for NSLN involvement. The calculated risk resulted in an AUC of 0.76. Applied to the external data, the model was accurate and discriminating for one (AUC = 0.75) and less for the other center (AUC = 0.58). A discriminative predictive model was constructed to calculate the risk of NSLN involvement in case of a positive SLN. External validation of our model reveals differences in performance when applied to data from other institutions concluding that such a predictive model requires validation prior to use.
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Anneleen
A
Reynders
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Olivier
O
Brouckaert
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Ann
A
Smeets
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Annouschka
A
Laenen
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Emi
E
Yoshihara
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Frederik
F
Persyn
Department of Pathology, KULeuven, University Hospitals, Herestraat 49, Belgium.
Giuseppe
G
Floris
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Karin
K
Leunen
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Frederic
F
Amant
Department of Radiology, KULeuven, University Hospitals, Herestraat 49, Belgium.
Julie
J
Soens
Department of Radiology, KULeuven, University Hospitals, Herestraat 49, Belgium.
Chantal
C
Van Ongeval
Department of Pathology, KULeuven, University Hospitals, Herestraat 49, Belgium.
Philippe
P
Moerman
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Ignace
I
Vergote
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium.
Marie-Rose
MR
Christiaens
Multidisciplinary Breast Center, General Hospital Groeninge Kortrijk, President Kennedylaan 4, Belgium.
Gracienne
G
Staelens
Multidisciplinary Breast Center, General Hospital Groeninge Kortrijk, President Kennedylaan 4, Belgium.
Koen
K
Van Eygen
Department of Pathology, General Hospital Groeninge Kortrijk, President Kennedylaan 4, Belgium.
Alain
A
Vanneste
Multidisciplinary Breast Center, General Hospital Sint-Augustinus Wilrijk, Oosterveldlaan 24, Belgium.
Peter
P
Van Dam
Department of Pathology, General Hospital Sint-Augustinus Wilrijk, Oosterveldlaan 24, Belgium.
Cecile
C
Colpaert
Multidisciplinary Breast Center, KULeuven, University Hospitals, Herestraat 49, Belgium. Electronic address: patrick.neven@uzleuven.be.
Patrick
P
Neven
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; 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; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D021701:Sentinel Lymph Node Biopsy
Breast cancer; External validation; Non-sentinel lymph node involvement; Prediction; Sentinel lymph node