title: Criteria derived from serum markers can precisely evaluate axillary status in breast cancer patients.
abstract: A noninvasive method to confirm the presence of lymph node metastases (LNM) in breast cancer patients is lacking. This study aimed to identify markers from peripheral blood that have diagnostic value in evaluating axillary LNM.
  
  
  
  We tested 26 factors in serum from 57 patients with resectable breast cancer by the Luminex assay. Differences between node-negative and node-positive patients were assessed. The diagnostic value of the factors was determined by further analyses and a validation test.
  
  
  
  Matrix metalloproteinase-1, hepatocyte growth factor, and chemokine ligand 5 were independent risk factors for LNM. However, receiver operating characteristic analysis showed that these factors alone were not ideal predictors. The LNM score (LNMS), derived from combining these markers, correlated significantly with numbers of positive lymph nodes. Patients with LNMS of 0 had few LNM, axillary lymph node dissection (ALND) could be avoided, and sentinel lymph node biopsy (SLNB) was unnecessary. Very high accuracy was achieved for patients with LNMS of 1 with SLNB using only methylene blue, patients with LNMS of 3 required ALND, and patients with LNMS of 2 needed SLNB using both a radioactive isotope and methylene blue, and ALND.
  
  
  
  The LNMS derived from matrix metalloproteinase-1, hepatocyte growth factor, and chemokine ligand 5 serum levels identified the axillary lymph node status with high accuracy. Patients with higher LNMS had a greater probability of LNM.
authors.affiliation: Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hangyu
authors.initials: H
authors.lastname: Wan
authors.affiliation: Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Breast Disease, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Zhenggui
authors.initials: Z
authors.lastname: Du
authors.affiliation: Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Breast Disease, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Quanyi
authors.initials: Q
authors.lastname: Long
authors.affiliation: Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Breast Disease, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lü
authors.affiliation: Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Breast Disease, West China Hospital, Sichuan University, Chengdu, China. Electronic address: lihongjiang@sohu.com.
authors.forename: Hongjiang
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D001365:Axilla; D015415:Biomarkers / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000097:blood* / Q000473:pathology; D018946:Chemokine CCL5 / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D017228:Hepatocyte Growth Factor / Q000097:blood; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D020781:Matrix Metalloproteinase 1 / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis
chemical_list: D015415:Biomarkers; C483024:CCL5 protein, human; D018946:Chemokine CCL5; D016207:Cytokines; C066855:HGF protein, human; D017228:Hepatocyte Growth Factor; C522360:MMP1 protein, human; D020781:Matrix Metalloproteinase 1
keywords: Axillary lymph node metastases; Breast cancer; Chemokine ligand; Hepatocyte growth factor; Matrix metalloproteinase; Sentinel lymph node biopsy