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. 2018 Aug;15(3):282-289.
doi: 10.20892/j.issn.2095-3941.2018.0023.

Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Amina Maimaitiaili  1 , Di Wu  1 , Zhenyu Liu  1 , Haimeng Liu  1 , Xiamusiye Muyiduli  2 , Zhimin Fan  1
Affiliations

Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Amina Maimaitiaili et al. Cancer Biol Med. 2018 Aug.

Erratum in

Abstract

Objective: Axillary lymph node dissection (ALND) may be unnecessary in 20%-60% of breast cancer patients with sentinel lymph node (NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.

Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy (SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph node-negative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.

Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients (32.1%). On univariate analysis, ≥ 3 positive NSLN metastases (P <0.01), NSLN macrometastases ( P = 0.023), and lymphovascular invasion (P = 0.04) were associated with non-NSLN metastasis (P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.

Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with non-SLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial (27.3%); thus, avoiding ALND should be considered carefully.

Keywords: Breast cancer; axillary lymph node dissection; non-sentinel lymph node metastasis; sentinel lymph node metastasis.

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Figures

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1
Schematic representation of nodal status. NSLN transfer ratio: number of NSLN involved/number of NSLN detected.
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2
Non-SLN rates when there are 0 to 3 risk factors. Risk factors include: (1) number of positive SLN ≥3; (2) SLN macrometastases; (3) lymphovascular invasion.
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