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http://dx.doi.org/10.7314/APJCP.2014.15.17.7049

Clinicopathologic Features Predicting Involvement of Nonsentinel Axillary Lymph Nodes in Iranian Women with Breast Cancer  

Moosavi, Seyed Alireza (Department of Surgery, Tehran University of Medical Sciences)
Abdirad, Afshin (Department of Pathology, Tehran University of Medical Sciences)
Omranipour, Ramesh (Department of Surgery, Tehran University of Medical Sciences)
Hadji, Maryam (Cancer Research Center, Tehran University of Medical Sciences)
Razavi, Amirnader Emami (Iran National Tumor Bank, Tehran University of Medical Sciences)
Najafi, Massoome (Department of Surgery, Tehran University of Medical Sciences)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.15, no.17, 2014 , pp. 7049-7054 More about this Journal
Abstract
Background: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. Materials and Methods: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. Results: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, were associated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4-268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. Conclusions: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.
Keywords
Breast cancer; sentinel node biopsy; non-sentinel node metastasis; predictors;
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1 Van Calster B, Bempt IV, Drijkoningen M, et al (2009). Axillary lymph node status of operable breast cancers by combined steroid receptor and HER-2 status: triple positive tumours are more likely lymph node positive. Breast Cancer Res Treat, 113, 181-7.   DOI
2 Van la Parra R, Peer P, Ernst M, et al (2011). Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol, 37, 290-9.   DOI
3 Van Zee KJ, Manasseh D-ME, Bevilacqua JL, et al (2003). A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol, 10, 1140-51.   DOI   ScienceOn
4 Viale G, Maiorano E, Pruneri G, et al (2005). Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg, 241, 319-25.   DOI   ScienceOn
5 Wada N, Imoto S, Yamauchi C, et al (2006). Predictors of tumour involvement in remaining axillary lymph nodes of breast cancer patients with positive sentinel lymph node. Eur J Surg Oncol, 32, 29-33.   DOI
6 Yu J, Hsu GC, Hsieh CB, et al (2005). Prediction of metastasis to non-sentinel nodes by sentinel node status and primary tumor characteristics in primary breast cancer in Taiwan. World J Surg, 29, 813-8.   DOI   ScienceOn
7 Altinyollar H, Berberoglu U, Gulben K, et al (2007). The correlation of extranodal invasion with other prognostic parameters in lymph node positive breast cancer. J Surg Oncol, 95, 567-71.   DOI   ScienceOn
8 Alvarenga CA, Santos CCd, Alvarenga M, et al (2013). Localization of metastasis within the sentinel lymph node biopsies: a predictor of additional axillary spread of breast cancer? Rev Bras Ginecol Obstet, 35, 483-99.   DOI
9 Ashikaga T, Krag DN, Land SR, et al (2010). Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol, 102, 111-8.   DOI
10 Baker TA, Wadhwani N, Rajan P, et al (2012). The size of metastasis in the sentinel node is a predictor of additional non-sentinel node positivity. J Cancer Ther, 3, 712-7.   DOI
11 Barranger E, Coutant C, Flahault A, et al (2005). 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, 113-9.   DOI   ScienceOn
12 Beriwal S, Soran A, Kocer B, et al (2008). Factors that predict the burden of axillary disease in breast cancer patients with a positive sentinel node. Am J Clin Oncol, 31, 34-8.   DOI
13 Bevilacqua JLB, Kattan MW, Fey JV, et al (2007). Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol, 25, 3670-9.   DOI   ScienceOn
14 Boler D, Uras C, Ince U, et al (2012). Factors predicting the nonsentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases. The Breast, 21, 518-23.   DOI
15 Bolster MJ, Peer PG, Bult P, et al (2007). Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study. Ann Surg Oncol, 14, 181-9.   DOI
16 Cady B (2001). Sentinel lymph node biopsy as an alternative to routine axillary lymph node dissection in breast cancer patients. J Surg Oncol, 77, 149-52.   DOI
17 Chu KU, Turner RR, Hansen NM, et al (1999). Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg, 229, 536-41.   DOI   ScienceOn
18 Degnim AC, Griffith KA, Sabel MS, et al (2003). Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer, 98, 2307-15.   DOI   ScienceOn
19 Dubsky PC, Gnant MF, Taucher S, et al (2002). Young age as an independent adverse prognostic factor in premenopausal patients with breast cancer. Clin Breast Cancer, 3, 65-72.   DOI
20 Eldweny H, Alkhaldy K, Alsaleh N, et al (2012). Predictors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node (Pilot study). J Egypt Natl Canc Inst, 24, 23-30.   DOI   ScienceOn
21 Kohrt HE, Olshen RA, Bermas HR, et al (2008). New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer, 8, 66.   DOI
22 Kwon Y, Ro J, Kang H-S, et al (2011). Clinicopathological parameters and biological markers predicting non-sentinel node metastasis in sentinel node-positive breast cancer patients. Oncol Rep, 25, 1063-71.
23 Lucci A, McCall LM, Beitsch PD, et al (2007). Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the american college of surgeons oncology group trial Z0011. J Clin Oncol, 25, 3657-63.   DOI   ScienceOn
24 McMasters KM, Tuttle TM, Carlson DJ, et al (2000). Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol, 18, 2560-6.
25 Mittendorf EA, Hunt KK, Boughey JC, et al (2012). Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg, 255, 109-15.   DOI
26 Mousavi SM, Montazeri A, Mohagheghi MA, et al (2007). Breast cancer in Iran: an epidemiological review. Breast J, 13, 383-91.   DOI   ScienceOn
27 Noguchi M (2008). Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer. Eur J Surg Oncol, 34, 129-34.   DOI   ScienceOn
28 Ozmen V, Karanlik H, Cabioglu N, et al (2006). Factors predicting the sentinel and non-sentinel lymph node metastases in breast cancer. Breast Cancer Res Treat, 95, 1-6.   DOI
29 Pal A, Provenzano E, Duffy S, et al (2008). A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive. Br J Surg, 95, 302-9.   DOI   ScienceOn
30 Fant JS, Grant MD, Knox SM, et al (2003). Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol, 10, 126-30.   DOI
31 Farshid G, Pradhan M, Kollias J, et al (2004). A decision aid for predicting non-sentinel node involvement in women with breast cancer and at least one positive sentinel node. The Breast, 13, 494-501.   DOI   ScienceOn
32 Friedman D, Gipponi M, Murelli F, et al (2013). Predictive factors of non-sentinel lymph node involvement in patients with invasive breast cancer and sentinel node micrometastases. Anticancer Res, 33, 4509-14.
33 Fujii T, Yanagita Y, Fujisawa T, et al (2010). Implication of extracapsular invasion of sentinel lymph nodes in breast cancer: prediction of nonsentinel lymph node metastasis. World J Surg, 34, 544-8.   DOI
34 Giuliano AE, Hunt KK, Ballman KV, et al (2011). Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA, 305, 569-75.   DOI   ScienceOn
35 Goyal A, Douglas-Jones A, Newcombe R, et al (2004). Predictors of non-sentinel lymph node metastasis in breast cancer patients. Eur J Cancer, 40, 1731-7.   DOI   ScienceOn
36 Guenther JM, Hansen NM, DiFronzo LA, et al (2003). Axillary dissection is not required for all patients with breast cancer and positive sentinel nodes. Arch Surg, 138, 52-6.   DOI   ScienceOn
37 Gur A, Unal B, Ozbek U, et al (2010). Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study. Eur J Surg Oncol, 36, 30-5.   DOI   ScienceOn
38 Guray Durak M, Akansu B, Akin MM, et al (2011). Factors predicting non-sentinel lymph node involvement in sentinel node positive breast carcinoma. Turk Patoloji Derg, 27, 189-95.
39 Harirchi I, Karbakhsh M, Kashefi A, et al (2004). Breast cancer in Iran: results of a multi-center study. Asian Pac J Cancer Prev, 5, 24-7.
40 Jeruss JS, Winchester DJ, Sener SF, et al (2005). Axillary recurrence after sentinel node biopsy. Ann Surg Oncol, 12, 34-40.   DOI   ScienceOn
41 Jinno H, Sakata M, Asaga S, et al (2008). Predictors to assess non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis. Breast J, 14, 551-5.   DOI
42 Kapur U, Rubinas T, Ghai R, et al (2007). Prediction of nonsentinel lymph node metastasis in sentinel node-positive breast carcinoma. Ann Diagn Pathol, 11, 10-2.   DOI
43 Koca B, Kuru B, Ozen N, et al (2014). A breast cancer nomogram for prediction of non-sentinel node metastasis-validation of fourteen existing models. Asian Pac J Cancer Prev, 15, 1481-8.   과학기술학회마을   DOI
44 Abdessalam SF, Zervos EE, Prasad M, et al (2001). Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg, 182, 316-20.   DOI   ScienceOn
45 Afsharfard A, Mozaffar M, Orang E, et al (2013). Trends in Epidemiology, Clinical and Histopathological Characteristics of Breast Cancer in Iran: Results of a 17 Year Study. Asian Pac J Cancer Prev, 14, 6905-11.   과학기술학회마을   DOI   ScienceOn
46 Aitken E, Osman M (2010). Factors affecting nodal status in invasive breast cancer: a retrospective analysis of 623 patients. Breast J, 16, 271-8.   DOI
47 Rahusen FD, Torrenga H, van Diest PJ, et al (2001). Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg, 136, 1059-63.   DOI   ScienceOn
48 Schrenk P, Rieger R, Shamiyeh A, et al (2000). Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer, 88, 608-14.   DOI
49 Scomersi S, Torelli L, Zanconati F, et al (2012). Evaluation of a breast cancer nomogram for predicting the likelihood of additional nodal metastases in patients with a positive sentinel node biopsy. Ann Ital Chir, 83, 461-8.
50 Silverstein MJ, Skinner KA, Lomis TJ (2001). Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg, 25, 767-72.   DOI   ScienceOn
51 Singletary SE, Allred C, Ashley P, et al (2002). Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol, 20, 3628-36.   DOI   ScienceOn
52 Singletary SE, Greene FL (2003). Revision of breast cancer staging: the 6th edition of the TNM Classification. Semin Surg Oncol, 21, 53-9   DOI   ScienceOn
53 Stitzenberg KB, Meyer AA, Stern SL, et al (2003). Extracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burden. Ann Surg, 237, 607-12.
54 Turner RR, Chu KU, Qi K, et al (2000). Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer, 89, 574-81.   DOI
55 Derici S, Sevinc A, Harmancioglu O, et al (2012). Validation of three breast cancer nomograms and a new formula for predicting non-sentinel lymph node status. Asian Pac J Cancer Prev, 13, 6181-5.   과학기술학회마을   DOI
56 Fougo JL, Afonso M, Senra FS, et al (2009). Predictive factors for non-sentinel lymph node involvement in breast cancer patients with a positive sentinel node: should we consider sentinel node-related factors? Clin Transl Oncol, 11, 165-71.   DOI
57 Van Deurzen C, Van Hillegersberg R, Hobbelink M, et al (2007). Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases. Cell Oncol, 29, 497-505.