Predictive Factors for Sentinel Lymph Node Metastasis and Validation of Memorial Sloan–Kettering Cancer Center Nomogram in Thai Breast Cancer Patients

Predictive Factors for Sentinel Node Metastasis

Authors

  • Anongporn Nimboriboonporn Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University
  • Doonyapat Sa-nguanraksa Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University
  • Norasate Samarnthai Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Thanawat Thumrongtaradol Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University
  • Surat Phumphuang Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University
  • Pornchai O-charoenrat Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University

Keywords:

Axillary staging, Breast cancer, Nodal metastasis, Nomogram, Sentinel lymph node

Abstract

Objectives: To evaluate risk factors for sentinel lymph node metastasis and validate value of the Memorial Sloan–Kettering Cancer Center (MSKCC) nomogram for the prediction of sentinel lymph node metastasis in Thai breast cancer patients.

Materials and Methods: Sentinel lymph node biopsy database containing 760 consecutive breast cancer patients was retrospectively analyzed. The predictive value of MSKCC nomogram was calculated by the trend line and the area under the receiver-operator characteristic curve. Meanwhile, predictors for sentinel lymph node metastasis were also evaluated.

Results: Tumor size, tumor type, tumor location, lymphovascular invasion, perineural invasion, multifocality, and progesterone receptor status were significant independent predictors for sentinel lymph node metastasis (all p < 0.05). The MSKCC nomogram presented an area under the receiver–operator characteristic curve value of 0.73. Patients with predictive value less than 12% had a frequency of sentinel lymph node metastasis of 0%. Those with values higher than 80% had a chance of sentinel lymph node metastasis of 78.3%.

Conclusions: The risk factors for sentinel lymph node metastasis in our study were partly similar to those in the MSKCC nomogram. The MSKCC nomogram is a useful tool that could accurately predict the probability of sentinel lymph node metastasis in our breast cancer patients. Axillary surgical staging might be avoided in patients with a predictive value of < 12% and axillary lymph node dissection might be performed in those with a predictive value of > 80%, while other patients should still require sentinel lymph node biopsy.

References

National Comprehensive Cancer Network. Breast Cancer (Version 3.2020) 2020 [Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.

Lyman GH, Somerfield MR, Giuliano AE. Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: 2016 American Society of Clinical Oncology Clinical Practice Guideline Update Summary. J Oncol Pract. 2017;13(3):196-8.

Sa-Nguanraksa D, Chuangsuwanich T, Pongpruttipan T, Kummalue T, Rojananin S, Ratanawichhitrasin A, et al. Vascular endothelial growth factor 634G/C polymorphism is associated with increased breast cancer risk and aggressiveness. Mol Med Rep. 2013;8(4):1242-50.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927-33.

Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599-609.

Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE. Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol. 2008;15(7):1996-2005.

Del Bianco P, Zavagno G, Burelli P, Scalco G, Barutta L, Carraro P, et al. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol. 2008;34(5):508-13.

Zavagno G, De Salvo GL, Scalco G, Bozza F, Barutta L, Del Bianco P, et al. A Randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg. 2008;247(2):207-13.

Vittayapipat N, Sa-nguanraksa D, Bhothisuwan K, Rojananin S, Ratanawichitrasin A, Prasartong-Osoth P, et al. Comparing Arm Morbidity Following Sentinel Lymph Node Biopsy and Axillary Lymph Node Dissection in Thai Patients with Early Breast Cancer. J Med Assoc Thai. 2017;100:S61-S70.

Baron RH, Fey JV, Borgen PI, Stempel MM, Hardick KR, Van Zee KJ. Eighteen sensations after breast cancer surgery: a 5-year comparison of sentinel lymph node biopsy and axillary lymph node dissection. Ann Surg Oncol. 2007;14(5):1653-61.

Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007;245(3):452-61.

McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213-9.

Peintinger F, Reitsamer R, Stranzl H, Ralph G. Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer. 2003;89(4):648-52.

Bader AA, Tio J, Petru E, Buhner M, Pfahlberg A, Volkholz H, et al. T1 breast cancer: identification of patients at low risk of axillary lymph node metastases. Breast Cancer Res Treat. 2002;76(1):11-7.

Bevilacqua JL, Kattan MW, Fey JV, Cody HS, 3rd, Borgen PI, Van Zee KJ. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol. 2007;25(24):3670-9.

Fehm T, Maul H, Gebauer S, Scharf A, Baier P, Sohn C, et al. Prediction of axillary lymph node status of breast cancer patients by tumorbiological factors of the primary tumor. Strahlenther Onkol. 2005;181(9):580-6.

Gonzalez-Vela MC, Garijo MF, Fernandez FA, Buelta L, Val-Bernal JF. Predictors of axillary lymph node metastases in patients with invasive breast carcinoma by a combination of classical and biological prognostic factors. Pathol Res Pract. 1999;195(9):611-8.

Guarnieri A, Neri A, Correale PP, Lottini M, Testa M, Mariani F, et al. Prediction of lymph node status by analysis of prognostic factors and possible indications for elective axillary dissection in T1 breast cancers. Eur J Surg. 2001;167(4):255-9.

Olivotto IA, Jackson JS, Mates D, Andersen S, Davidson W, Bryce CJ, et al. Prediction of axillary lymph node involvement of women with invasive breast carcinoma: a multivariate analysis. Cancer. 1998;83(5):948-55.

Ravdin PM, De Laurentiis M, Vendely T, Clark GM. Prediction of axillary lymph node status in breast cancer patients by use of prognostic indicators. J Natl Cancer Inst. 1994;86(23):1771-5.

Rivadeneira DE, Simmons RM, Christos PJ, Hanna K, Daly JM, Osborne MP. Predictive factors associated with axillary lymph node metastases in T1a and T1b breast carcinomas: analysis in more than 900 patients. J Am Coll Surg. 2000;191(1):1-6; discussion -8.

Yip CH, Taib NA, Tan GH, Ng KL, Yoong BK, Choo WY. Predictors of axillary lymph node metastases in breast cancer: is there a role for minimal axillary surgery? World J Surg. 2009;33(1):54-7.

Reyal F, Rouzier R, Depont-Hazelzet B, Bollet MA, Pierga JY, Alran S, et al. The molecular subtype classification is a determinant of sentinel node positivity in early breast carcinoma. PLoS One. 2011;6(5):e20297.

Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111-8.

Wilke LG, McCall LM, Posther KE, Whitworth PW, Reintgen DS, Leitch AM, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13(4):491-500.

Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426-32; discussion 32-3.

Poirier E, Sideris L, Dube P, Drolet P, Meterissian SH. Analysis of clinical applicability of the breast cancer nomogram for positive sentinel lymph node: the canadian experience. Ann Surg Oncol. 2008;15(9):2562-7.

Van Zee KJ, Manasseh DM, Bevilacqua JL, Boolbol SK, Fey JV, Tan LK, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10(10):1140-51.

Klar M, Foeldi M, Markert S, Gitsch G, Stickeler E, Watermann D. Good prediction of the likelihood for sentinel lymph node metastasis by using the MSKCC nomogram in a German breast cancer population. Ann Surg Oncol. 2009;16(5):1136-42.

Patani NR, Dwek MV, Douek M. Predictors of axillary lymph node metastasis in breast cancer: a systematic review. Eur J Surg Oncol. 2007;33(4):409-19.

Lyman GH, Giuliano AE, Somerfield MR, Benson AB, 3rd, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-20.

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Published

2020-06-30

How to Cite

1.
Nimboriboonporn A, Sa-nguanraksa D, Samarnthai N, Thumrongtaradol T, Phumphuang S, O-charoenrat P. Predictive Factors for Sentinel Lymph Node Metastasis and Validation of Memorial Sloan–Kettering Cancer Center Nomogram in Thai Breast Cancer Patients: Predictive Factors for Sentinel Node Metastasis. Thai J Surg [Internet]. 2020 Jun. 30 [cited 2024 Nov. 6];41(2):29-3. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/241208

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