title: Predictive factors for additional non-sentinel lymph node involvement in breast cancer patients with one positive sentinel node.
abstract: OBJECTIVE
  The aim of this study was to identify a subgroup of breast cancer patients in whom it is possible to avoid axillary lymph node dissection (ALND) when the sentinel lymph node (SLN) is positive.
  
  
  METHODS
  A series of 292 patients treated with breast-conserving surgery or mastectomy underwent ALND after positive SLN detection. To correlate SLN metastasis with the chances of finding additional metastasis in non-SLNs we evaluated the main clinicopathological characteristics. No patients received adjuvant radiotherapy to the axillary region.
  
  
  RESULTS
  Fifty-six patients (35.4%) with positive SLNs for macrometastases (n = 158) had additional metastases upon completion ALND compared with 7 patients (5.2%) with micrometastases in the SLN (n = 132). Cases with a higher number of positive axillary lymph nodes tended to have higher pT stage (p = 0.004). In multivariate analysis, pT was confirmed as an independent predictor of non-SLN metastases (OR = 2.40; 95% CI = 1.16-4.99). No patients with micrometastases in SLN and cancer lt;10 mm had additional positive non-SLNs.
  
  
  CONCLUSIONS
  Our results, in agreement with the major published studies, suggest that ALND can be avoided in selected patients without the need for additional treatment to the axillary region.
authors.affiliation: Department of Radiation-Oncology, University of Florence, Florence - Italy.
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertocci
authors.forename: Giulio
authors.initials: G
authors.lastname: Francolini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zei
authors.forename: Carla
authors.initials: C
authors.lastname: De Luca Cardillo
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.forename: Daniela
authors.initials: D
authors.lastname: Greto
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Bonomo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Orzalesi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D018275:Carcinoma, Lobular / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D061206:Neoplasm Micrometastasis / Q000175:diagnosis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy
chemical_list: D014408:Biomarkers, Tumor