Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery.
- Author:
Soo Kyung AHN
1
;
Min Kyoon KIM
;
Jongjin KIM
;
Eunshin LEE
;
Tae Kyung YOO
;
Han Byoel LEE
;
Young Joon KANG
;
Jisun KIM
;
Hyeong Gon MOON
;
Jung Min CHANG
;
Nariya CHO
;
Woo Kyung MOON
;
In Ae PARK
;
Dong Young NOH
;
Wonshik HAN
Author Information
- Publication Type:Original Article
- Keywords: Sentinel lymph node; Nomograms; Z0011; Breast neoplasms; Chest; Computed tomography; Axilla sonography
- MeSH: Breast Neoplasms*; Breast*; Female; Humans; Logistic Models; Lymph Nodes*; Mastectomy, Segmental; Multivariate Analysis; Nomograms*; Prospective Studies; ROC Curve; Surgeons; Thorax
- From:Cancer Research and Treatment 2017;49(4):1088-1096
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The American College of Surgeons Oncology Group Z0011 trial reported that complete dissection of axillary lymph nodes (ALNs) may not be warranted in women with clinical T1-T2 tumors and one or two involved ALNs who were undergoing lumpectomy plus radiation followed by systemic therapy. The present study was conducted to identify preoperative imaging predictors of ≥ 3 ALNs. MATERIALS AND METHODS: The training set consisted of 1,917 patients with clinical T1-T2 and node negative invasive breast cancer. Factors associated with ≥ 3 involved ALNs were evaluated by logistic regression analysis. The validation set consisted of 378 independent patients. The nomogram was applied prospectively to 512 patients who met the Z0011 criteria. RESULTS: Of the 1,917 patients, 204 (10.6%) had ≥ 3 positive nodes. Multivariate analysis showed that involvement of ≥ 3 nodes was significantly associated with ultrasonographic and chest computed tomography findings of suspicious ALNs (p < 0.001 each). These two imaging criteria, plus patient age, were used to develop a nomogram calculating the probability of involvement of ≥ 3 ALNs. The areas under the receiver operating characteristic curve of the nomogram were 0.852 (95% confidence interval [CI], 0.820 to 0.883) for the training set and 0.896 (95% CI, 0.836 to 0.957) for the validation set. Prospective application of the nomogram showed that 60 of 512 patients (11.7%) had scores above the cut-off. Application of the nomogram reduced operation time and cost, with a very low re-operation rate (1.6%). CONCLUSION: Patients likely to have ≥ 3 positive ALNs could be identified by preoperative imaging. The nomogram was helpful in selective intraoperative examination of sentinel lymph nodes.
