Skip to main content

Advertisement

Log in

An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement

  • Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background. Axillary lymph node dissection (ALND) is the current standard of care for breast cancer patients with sentinel lymph node (SN) involvement. However, the SN is the only involved axillary node in a significant proportion of these patients. Here we examined factors predictive of non-SN involvement in patients with a metastatic SN, in order to develop a scoring system for predicting non-SN involvement.

Materials and Methods. This study was based on a prospective database of 337 patients who underwent SN biopsy for breast cancer, of whom 81 (24) were SN-positive; we examined factors predictive of non SN involvement in the 71 of these 81 women who underwent complementary ALND. All clinical and histological criteria were recorded and analysed according to non-SN status, by using Chi-2 analysis, Student’s t-test, and multivariate logistic regression.

Results. Univariate analysis showed a significant association between non-SN involvement and histological primary tumor size (p=0.0001), SN macrometastasis (p=0.01), the method used to detect SN metastasis (H&E versus immunohistochemistry) (p=0.03), the number of positive SNs (p=0.049), the proportion of involved SNs among all identified SNs (p=0.0001) and lymphovascular invasion (p=0.006). Histological primary tumor size (p=0.006), SN macrometastasis (p=0.02) and the proportion of involved SNs among all identified SNs (p=0.03) remained significantly associated with non-SN status in multivariate analysis. Based on the multivariate analysis, we developed an axilla scoring system (range 0–7) to predict the likelihood of non-SN metastasis in breast cancer patients with SN involvement.

Conclusion. In patients with invasive breast cancer and a positive SN, histological primary tumor size, the size of SN metastases, and the proportion of involved SNs among all identified SNs were independently predictive of non-SN involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. CL Carter C Allen DE Henson (1989) ArticleTitleRelation of tumor size, lymph node status, and survival in 24,740 breast cancer cases Cancer 63 181–187 Occurrence Handle1:STN:280:DyaL1M%2FovFCqug%3D%3D Occurrence Handle2910416

    CAS  PubMed  Google Scholar 

  2. AL Hoe D Iven GT Royle I Taylor (1992) ArticleTitleIncidence of arm swelling following axillary clearance for breast cancer Br J Surg 79 261–262 Occurrence Handle1:STN:280:DyaK383gvVOhtQ%3D%3D Occurrence Handle1555097

    CAS  PubMed  Google Scholar 

  3. DN Krag DL Weaver JC Alex JT Fairbank (1993) ArticleTitleSurgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe Surg Oncol 2 335–340 Occurrence Handle10.1016/0960-7404(93)90064-6 Occurrence Handle1:STN:280:DyaK2c7nslegtQ%3D%3D Occurrence Handle8130940

    Article  CAS  PubMed  Google Scholar 

  4. AE Giuliano DM Kirgan JM Guenther DL Morton (1994) ArticleTitleLymphatic mapping and sentinel lymphadenectomy for breast cancer Ann Surg 220 391–401 Occurrence Handle1:STN:280:DyaK2cznvFyksA%3D%3D Occurrence Handle8092905

    CAS  PubMed  Google Scholar 

  5. KU Chu RR Turner NM Hansen MB Brennan AE Giuliano (1999) ArticleTitleSentinel node metastasis in patients with breast carcinoma accurately predicts immunohistochemically detec table nonsentinel node metastasis Ann Surg Oncol 6 756–761 Occurrence Handle10.1007/s10434-999-0756-2 Occurrence Handle1:STN:280:DC%2BD3c%2Fos1aitw%3D%3D Occurrence Handle10622503

    Article  CAS  PubMed  Google Scholar 

  6. VJ Kamath R Giuliano EL Dauway et al. (2001) ArticleTitleCharacteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection Arch Surg 136 688–692 Occurrence Handle10.1001/archsurg.136.6.688 Occurrence Handle1:STN:280:DC%2BD3MzlvVersA%3D%3D Occurrence Handle11387010

    Article  CAS  PubMed  Google Scholar 

  7. U Sachdev K Murphy A Derzie et al. (2002) ArticleTitlePredictors of non-sentinel lymph node metastasis in breast cancer patients Am J Surg 183 213–217 Occurrence Handle10.1016/S0002-9610(02)00794-8 Occurrence Handle11943113

    Article  PubMed  Google Scholar 

  8. KB Stitzenberg AA Meyer SL Stern et al. (2003) ArticleTitleExtracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burden Ann Surg 237 607–612 Occurrence Handle10.1097/00000658-200305000-00002 Occurrence Handle12724626

    Article  PubMed  Google Scholar 

  9. B Fisher C Redmond ER Fisher et al. (1988) ArticleTitleTen-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation N Engl J Med 312 674–681 Occurrence Handle10.1056/NEJM198503143121102

    Article  Google Scholar 

  10. KU Chu RR Turner NM Hansen et al. (1999) ArticleTitleDo all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 229 536–541 Occurrence Handle10.1097/00000658-199904000-00013 Occurrence Handle1:STN:280:DyaK1M3hslOgtQ%3D%3D Occurrence Handle10203087

    Article  CAS  PubMed  Google Scholar 

  11. KJ Van Zee DME Manasseh JLB Bevilacqua et al. (2003) ArticleTitleA nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy Ann Surg Oncol 10 1140–1151 Occurrence Handle10.1245/ASO.2003.03.015 Occurrence Handle14654469

    Article  PubMed  Google Scholar 

  12. RF Saidi PS Dubrick SG Remine VK Mittal (2004) ArticleTitleNonsentinel lymph node status after positive sentinel lymph node biopsy in early breast cancer Am Surg 70 101–105 Occurrence Handle15011910

    PubMed  Google Scholar 

  13. JP Travagli D Atallah MC Mathieu et al. (2003) ArticleTitleSentinel lymphadenectomy without systematic axxilary dissection in breast cancer patients: predictors of non-sentinel lymph node metastasis Eur J Surg Oncol 29 403–406 Occurrence Handle10.1053/ejso.2002.1427 Occurrence Handle12711299

    Article  PubMed  Google Scholar 

  14. C Reynolds R Mick JH Donohue et al. (1999) ArticleTitleSentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol 17 1720–1726 Occurrence Handle1:STN:280:DC%2BD3c%2FivF2gtQ%3D%3D Occurrence Handle10561208

    CAS  PubMed  Google Scholar 

  15. RR Turner KU Chu K Qi et al. (2000) ArticleTitlePathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node Cancer 89 574–581 Occurrence Handle10.1002/1097-0142(20000801)89:3<574::AID-CNCR12>3.0.CO;2-Y Occurrence Handle1:STN:280:DC%2BD3cvgt1arsA%3D%3D Occurrence Handle10931456

    Article  CAS  PubMed  Google Scholar 

  16. G Viale E Maiorano G Mazzarol et al. (2001) ArticleTitleHistologic detection and clinical implications of micrometastases in axillary sentinel lymph nodes for patients with breast carcinoma Cancer 92 1378–1384 Occurrence Handle10.1002/1097-0142(20010915)92:6<1378::AID-CNCR1460>3.0.CO;2-Y Occurrence Handle1:STN:280:DC%2BD3MnpvV2lsQ%3D%3D Occurrence Handle11745213

    Article  CAS  PubMed  Google Scholar 

  17. MR Weiser LL Montgomery LK Tan et al. (2001) ArticleTitleLymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes Ann Surg Oncol 8 145–149 Occurrence Handle1:STN:280:DC%2BD3Mzgt1agtg%3D%3D Occurrence Handle11258779

    CAS  PubMed  Google Scholar 

  18. SL Wong MJ Edwards C Chao et al. (2001) ArticleTitleUniversity of Louisville Breast Cancer Sentinel Lymph Node Study Group. Predicting the status of the nonsentinel axillary nodes: a multicenter study Arch Surg 136 563–568 Occurrence Handle10.1001/archsurg.136.5.563 Occurrence Handle1:STN:280:DC%2BD3Mzht1OnsQ%3D%3D Occurrence Handle11343548

    Article  CAS  PubMed  Google Scholar 

  19. C Nos C Harding-MacKean P Freneaux et al. (2003) ArticleTitlePrediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastases Br J Surg 90 1354–1360 Occurrence Handle10.1002/bjs.4325 Occurrence Handle1:STN:280:DC%2BD3srhvV2rtA%3D%3D Occurrence Handle14598414

    Article  CAS  PubMed  Google Scholar 

  20. V Iterson ParticleVan M Leidenius L Krogerus K. Smitten Particlevon (2003) ArticleTitlePredictive factors for the status of non-sentinel nodes in breast cancer patients with tumor positive sentinel nodes Breast Cancer Res Treat 82 39–45 Occurrence Handle10.1023/B:BREA.0000003918.59396.e4 Occurrence Handle14672402

    Article  PubMed  Google Scholar 

  21. K Fournier A Schiller RR Perry C Laronga (2004) ArticleTitleMicrometastasis in the sentinel lymph node of breast cancer does not mandate completion axillary dissection Ann Surg 239 859–865 Occurrence Handle10.1097/01.sla.0000128302.05898.a7 Occurrence Handle15166965

    Article  PubMed  Google Scholar 

  22. FJ Fleming D Kavanagh TB Crotty et al. (2004) ArticleTitleFactors affecting metastases to non-sentinel lymph nodes in breast cancer J Clin Pathol 57 73–76 Occurrence Handle10.1136/jcp.57.1.73 Occurrence Handle1:STN:280:DC%2BD3snhtVKrtQ%3D%3D Occurrence Handle14693840

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emmanuel Barranger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barranger, E., Coutant, C., Flahault, A. et al. An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat 91, 113–119 (2005). https://doi.org/10.1007/s10549-004-5781-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-004-5781-z

Keywords

Navigation