title: Subtype is a predictive factor of nonsentinel lymph node involvement in sentinel node-positive breast cancer patients.
abstract: OBJECTIVE
  This study aimed to identify the effect of breast cancer subtype on nonsentinel lymph node (NSLN) metastasis in patients with a positive sentinel lymph node (SLN).
  
  
  METHODS
  The records of 104 early breast cancer patients with a positive SLN between April 2009 and September 2013 were retrospectively evaluated. All patients underwent axillary lymph node dissection. The effects of the tumor subtype (luminal A, luminal/HER2+, human epidermal growth factor receptor 2 [HER2] overexpression, and triple-negative) and other clinicopathological factors on NSLN metastasis were examined by univariate and multivariate statistical analyses.
  
  
  RESULTS
  Fifty of 104 patients (48%) exhibited NSLN metastasis. Univariate and multivariate analyses revealed that tumor size and the ratio of positive SLNs were significant risk factors of NSLN metastasis in patients with a positive SLN. The rate of NSLN metastasis was higher in patients with luminal/HER2+ and HER2 overexpression subtypes than that in patients with other subtypes in the univariate analysis (p<0.001). In the multivariate analysis, both patients with luminal/HER2+ (p<0.006) and patients with HER2 overexpression (p<0.031) subtypes had a higher risk of NSLN metastasis than patients with the luminal A subtype.
  
  
  CONCLUSIONS
  Subtype classification should be considered as an independent factor when evaluating the risk of NSLN metastasis in patients with a positive SLN. This result supports the development of new nomograms including breast cancer subtype to increase predictive accuracy.
authors.affiliation: Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Kaptan
authors.initials: K
authors.lastname: Gülben
authors.affiliation: Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Berberoğlu
authors.affiliation: Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Ogün
authors.initials: O
authors.lastname: Aydoğan
authors.affiliation: Department of Surgery, Samsun Training and Research Hospital, Samsun, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Kınaş
keywords: Breast neoplasms; Molecular subtypes; Predictive value of tests; Sentinel lymph node biopsy