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. 2005 Feb;241(2):319-25.
doi: 10.1097/01.sla.0000150255.30665.52.

Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy

Giuseppe Viale  1 , Eugenio Maiorano, Giancarlo Pruneri, Mauro G Mastropasqua, Stefano Valentini, Viviana Galimberti, Stefano Zurrida, Patrick Maisonneuve, Giovanni Paganelli, Giovanni Mazzarol
Affiliations

Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy

Giuseppe Viale et al. Ann Surg. 2005 Feb.

Abstract

Objective: To assess whether the risk for nonsentinel node metastases may be predicted, thus sparing a subgroup of patients with breast carcinoma and a positive sentinel lymph node (SLN) biopsy completion axillary lymph node dissection (ALND).

Summary background data: The SLN is the only involved axillary lymph node in the majority of the patients undergoing ALND for a positive SLN biopsy. A model to predict the status of nonsentinel axillary lymph nodes could help tailor surgical therapy to those patients most likely to benefit from completion ALND.

Methods: All the axillary sentinel and nonsentinel lymph nodes of 1228 patients were reviewed histologically and reclassified according to the current TNM classification of malignant tumors as bearing isolated tumor cells only, micrometastases, or (macro)metastases. The prevalence of metastases in nonsentinel lymph nodes was correlated to the type of SLN involvement and the size of the metastasis, the number of affected SLNs, and the prospectively collected clinicopathologic variables of the primary tumors.

Results: In multivariate analysis, further axillary involvement was significantly associated with the type and size of SLN metastases, the number of affected SLNs, and the occurrence of peritumoral vascular invasion in the primary tumor. A predictive model based on the characteristics most strongly associated with nonsentinel node metastases was able to identify subgroups of patients at significantly different risk for further axillary involvement.

Conclusions: Patients with the most favorable combination of predictive factors still have no less than 13% risk for nonsentinel lymph node metastases and should be offered completion ALND outside of clinical trials of SLN biopsy without back-up axillary clearing.

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References

    1. Schwartz GF, Giuliano AE, Veronesi U, et al. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19–22, 2001, Philadelphia, Pennsylvania. Cancer. 2002;94:2542–2551. - PubMed
    1. Wong SL, Edwards MJ, Chao C, et al. Predicting the status of the nonsentinel axillary nodes: a multicenter study. Arch Surg. 2001;136:563–568. - PubMed
    1. Rahusen FD, Torrenga H, van Diest PJ, et al. Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg. 2001;136:1059–1063. - PubMed
    1. den Bakker MA, van Weeszenberg A, de Kanter AY, et al. Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis: too early to abandon axillary clearance. J Clin Pathol. 2002;55:932–935. - PMC - PubMed
    1. Sachdev U, Murphy K, Derzie A, et al. Predictors of nonsentinel lymph node metastasis in breast cancer patients. Am J Surg. 2002;183:213–217. - PubMed