scholarly journals Imaging Predictors for Nonsentinel Lymph Node Metastases in Breast Cancer Patients

Breast Care ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 372-379
Author(s):  
Yizi Cong ◽  
Suxia Wang ◽  
Haidong Zou ◽  
Shiguang Zhu ◽  
Xingmiao Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Tumor Burden ◽  
Axillary Lymph ◽  
Imaging Features ◽  
Breast Cancer Patients ◽  
Size Number ◽  
Positive Slns ◽  
Nonsentinel Lymph Node

Background: The relationship between imaging features and nonsentinel lymph node (NSLN) metastasis is not clear. Objectives: To determine whether imaging features could predict NSLN metastasis in sentinel lymph node (SLN)-positive breast cancer patients and to provide new clues for avoiding unnecessary axillary lymph node dissection. Method: 171 patients with clinically negative axillary lymph nodes and a pathologically positive SLN were recruited between January 2007 and January 2014. According to the Breast Imaging Reporting and Data System (BI-RADS), the effects of clinicopathological factors, especially imaging features, on NSLN metastases were assessed by univariate and multivariate statistical analyses. Results: The average number of dissected SLNs was 2.11 (range, 1–6); 56 of the 171 (32.75%) patients exhibited NSLN metastases. In univariate analysis, tumor size, number of positive SLNs, ratio of positive SLNs, mammographic mass margins, ultrasonographic mass margins, and ultrasonographic vascularity were significantly correlated with NSLN involvement. Furthermore, through multivariate analysis, tumor size, number of positive SLNs, mammographic mass margins, and ultrasonographic vascularity were still independent predictors of NSLN involvement. Additionally, in SLN-positive patients, number of positive SLNs and ultrasonographic vascularity could also predict the tumor burden in NSLN. Conclusions: In addition to tumor size and the number of positive SLNs, mammographic mass margins and ultrasonographic vascularity were also independent predictors of NSLN metastases in SLN-positive patients of breast cancer. The number of positive SLNs and ultrasonographic vascularity could also predict the tumor burden in NSLN.

scholarly journals Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaochan Ou ◽  
Jianbin Zhu ◽  
Yaoming Qu ◽  
Chengmei Wang ◽  
Baiye Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Regression Analysis ◽  
Lymph Node ◽  
Cortical Thickness ◽  
Multidetector Row Computed Tomography ◽  
Axillary Lymph ◽  
Imaging Features ◽  
Short Axis ◽  
Breast Cancer Patients

Abstract Introduction Accurately assessing axillary lymph node (ALN) status in breast cancer is vital for clinical decision making and prognosis. The purpose of this study was to evaluate the predictive value of sentinel lymph node (SLN) mapped by multidetector-row computed tomography lymphography (MDCT-LG) for ALN metastasis in breast cancer patients. Methods 112 patients with breast cancer who underwent preoperative MDCT-LG examination were included in the study. Long-axis diameter, short-axis diameter, ratio of long-/short-axis and cortical thickness were measured. Logistic regression analysis was performed to evaluate independent predictors associated with ALN metastasis. The prediction of ALN metastasis was determined with related variables of SLN using receiver operating characteristic (ROC) curve analysis. Results Among the 112 cases, 35 (30.8%) cases had ALN metastasis. The cortical thickness in metastatic ALN group was significantly thicker than that in non-metastatic ALN group (4.0 ± 1.2 mm vs. 2.4 ± 0.7 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of > 3.3 mm (OR 24.53, 95% CI 6.58–91.48, P < 0.001) had higher risk for ALN metastasis. The best sensitivity, specificity, negative predictive value(NPV) and AUC of MDCT-LG for ALN metastasis prediction based on the single variable of cortical thickness were 76.2%, 88.5%, 90.2% and 0.872 (95% CI 0.773–0.939, P < 0.001), respectively. Conclusion ALN status can be predicted using the imaging features of SLN which was mapped on MDCT-LG in breast cancer patients. Besides, it may be helpful to select true negative lymph nodes in patients with early breast cancer, and SLN biopsy can be avoided in clinically and radiographically negative axilla.

scholarly journals Predictors of Nonsentinel Nodal Involvement to Aid Intraoperative Decision Making in Breast Cancer Patients with Positive Sentinel Lymph Nodes

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Ern Yu Tan ◽  
Bernard Ho ◽  
Juliana J. C. Chen ◽  
Pey Woei Ho ◽  
Christine Teo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Positive Sentinel Lymph Node ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Nodal Involvement ◽  
Node Dissection ◽  
Positive Slns ◽  
Mskcc Nomogram

Background. Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods. Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results. Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs (P=0.04), macrometastasis (P=0.01), and inversely with the total number of SLNs harvested (P=0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions. The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND.

scholarly journals Changes of breast cancer staging when AJCC prognostic staging manual is used: a retrospective analysis of a Chinese cohort

2017 ◽  
Vol 33 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Jinhua Ding ◽  
Weizhu Wu ◽  
Jianjiang Fang ◽  
Yudong Chu ◽  
Siming Zheng ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Tumor Size ◽  
Medical Center ◽  
Univariate Analysis ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Ajcc Staging

Background: This study aimed to investigate staging changes for Chinese breast cancer patients assessed by the 7th (anatomic) and 8th (prognostic) editions of the AJCC staging manual, and to explore the predictive factors for these changes. Methods: Data of patients who received curative surgery for stage I-III breast cancer at Ningbo Medical Center Lihuili Eastern Hospital were retrospectively reviewed. The assessment of staging was according to the criteria of the 7th and 8th editions of the AJCC staging manual. Univariate and multivariate logistic regression analyses were performed to analyze the associations between staging changes and clinicopathological characteristics. Results: Staging changes were found in 59.37% of patients and were more likely to be seen in stage IIIA (96.10%) and IIA (85.94%), then IIB (70.33%), IB (68.75%), followed by IA (36.17%) and IIIC (30.08%). In univariate analysis, staging changes were associated with tumor location, clinical tumor size, clinical axillary lymph node status and Ki67 index. However, multivariate analysis found that staging changes were significantly associated with tumor size >2 cm (odds ratio [OR] = 3.263, 95% confidence interval [95% CI], 2.638-4.036), lymph node involvement (OR = 2.261, 95% CI, 1.830-2.794) and high Ki-67 index (OR = 1.661, 95% CI 1.343-2.054). Conclusions: Our study demonstrated that there were marked staging changes when 2 different editions of the AJCC staging manual were used. Since prognostic biomarkers are available in routine clinical practice, the more recent staging manual should be followed to select better systemic therapy and give better outcomes for Chinese breast cancer patients.

scholarly journals Candidates of Genomic Tests in HR+/HER2- Breast Cancer Patients With 1-2 Positive Sentinel Lymph Node Without Axillary Lymph Node Dissection: Analysis From Multicentric Cohorts

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhao Bi ◽  
Jia-Jian Chen ◽  
Peng-Chen Liu ◽  
Peng Chen ◽  
Wei-Li Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Internal Validation ◽  
Her2 Breast Cancer ◽  
Positive Slns

BackgroundThe genomic tests such as the MammaPrint and Oncotype DX test are being gradually applied for hormone receptor positive/HER-2 negative (HR+/HER2-) breast cancer patients with up to three positive axillary lymph nodes (ALNs). The first results from RxPONDER trial suggested that Oncotype DX could be applied to patients with 1-2 positive sentinel lymph nodes (SLNs) without axillary lymph node dissection (ALND), which constituted 37.4% of the intent-to-treat population. However, there was no distinctive research on how to apply genomic tests precisely to HR+/HER2- patients with 1-2 positive SLNs without ALND. The purpose was to construct a nomogram using the multi-center retrospective data to predict precisely which HR+/HER2- candidates with 1-2 positive SLNs could be subjected to genomic tests (≤ 3 positive lymph nodes).MethodsWe conducted a retrospective analysis of 18,600 patients with stage I-III breast cancer patients treated with sentinel lymph node biopsy (SLNB) in Shandong Cancer Hospital, Fudan University Shanghai Cancer Center, and West China Hospital. The univariate and multivariate logistic regression analysis was conducted to identify the independent predictive factors of having ≤ 3 positive nodes among patients with 1-2 positive SLNs. A nomogram was developed based on variables in the final model with p&lt;0.05. Calibration of the nomogram was carried out by internal validation using the bootstrap resampling approach and was displayed using a calibration curve. The discrimination of the model was evaluated using the ROC curve.ResultsBased on the database of the three institutions, a total of 18,600 breast cancer patients were identified undergoing SLNB between May 2010 and 2020. Among the 1817 HR+/HER2- patients with 1-2 positive SLNs undergoing ALND, 84.2% harbored ≤ 3 totals metastatic ALNs. The multivariate logistic regression analysis identified imaging abnormal nodes (OR=0.197, 95%CI: 0.082-0.472), the number of positive SLNs (OR=0.351, 95%CI: 0.266-0.464), the number of negative SLNs (OR=1.639, 95%CI: 1.465-1.833), pathological tumor stage (OR=0.730, 95%CI: 0.552-0.964), and lympho-vascular invasion (OR=0.287, 95%CI: 0.222-0.398) as independent predictors for the proportion of patients with ≤ 3 total metastatic ALNs (all p&lt;0.05). These five predictors were used to create a predictive nomogram. The AUC value was 0.804 (95%CI: 0.681-0.812, p&lt;0.001). The calibration curve showed a satisfactory fit between the predictive and actual observation based on internal validation with a bootstrap resampling frequency of 1000.ConclusionThe nomogram based on the multi-centric database showed a good accuracy and could assist the oncologist in determining precisely which HR+/HER2- candidates with 1-2 positive SLNs without ALND could perform genomic tests. In the era of SLNB and precision medicine, the combined application of genomic tests and SLNB could provide patients with a better strategy of dual de-escalation management, including the de-escalation of both surgery and systemic treatment.

scholarly journals Axillary Dissection in Breast Cancer Patients with Metastatic Sentinel Node: To Do or Not to Do? Suggestions from Our Series

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
M. Bortolini ◽  
F. Genta ◽  
Chiara Perono Biacchiardi ◽  
E. Zanon ◽  
M. Camanni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Node ◽  
Needle Aspiration ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Positive Slns ◽  
Almost All

Several studies have put to question and evaluated the indication and prognosis of sentinel lymph node biopsy (SNLB) as sole treatment in human breast cancer. We reviewed 1588 patients who underwent axillary surgery. In 239 patients, axillary lymph node dissection (ALND) was performed following positive fine needle aspiration cytology (FNAC), and, in 299 cases, ALND was executed after positive SNLB. The most dramatic result from our data is that patients with either micrometastasis of the sentinel lymph node (SLN) or only metastatic SLN have, respectively, an 84.5% and a 75.0% chance of having no other nodal involvement. We believe a more refined patient selection is neccessary when considering ALND. Where the primary tumor is larger than 5 cm, where radio or adjuvant therapies are not indicated, in cases of FNAC+ nodes, and in cases presenting more than one metastatic sentinel node, we prefer to carry out ALND. Having thus said, however, our data suggests that it is wise not to perform ALND in almost all cases presenting positive SLNs.

scholarly journals A Novel Predictive Nomogram including Serum Lipoprotein a Level for Nonsentinel Lymph Node Metastases in Chinese Breast Cancer Patients with Positive Sentinel Lymph Node Metastases

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Zeng Fang ◽  
Ruizhi Wang ◽  
Ciqiu Yang ◽  
Dong Wang ◽  
Wanna Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Lymph Node Metastases ◽  
Axillary Lymph ◽  
Clinicopathologic Features ◽  
Breast Cancer Patients ◽  
Lipoprotein A ◽  
Node Metastases ◽  
Nonsentinel Lymph Node

Background. We developed a new nomogram combining serum biomarkers with clinicopathological features to improve the accuracy of prediction of nonsentinel lymph node (SLN) metastases in Chinese breast cancer patients. Methods. We enrolled 209 patients with breast cancer who underwent SLN biopsy and axillary lymph node dissection. We evaluated the relationships between non-SLN metastases and clinicopathologic features, as well as preoperative routine tests of blood indexes, tumor markers, and serum lipids, including lipoprotein a (Lp(a)). Risk factors for non-SLN metastases were identified by logistic regression analysis. The nomogram was created using the R program to predict the risk of non-SLN metastases in the training set. Receiver operating characteristic (ROC) analysis was applied to assess the predictive value of the nomogram model in the validation set. Results. Lp(a) was significantly associated with non-SLN metastasis status. Compared with the MSKCC model, the predictive ability of our new nomogram that combined Lp(a) level and clinical variables (pathologic tumor size, lymphovascular invasion, multifocality, and positive/negative SLN numbers) was significantly greater (AUC: 0.732, 95% CI: 0.643–0.821) (C-index: 0.703, 95% CI: 0.656–0.791) in the training cohorts and also performed well in the validation cohorts (C-index: 0.773, 95% CI: 0.681–0.865). Moreover, the new nomogram with Lp(a) improved the accuracy (12.10%) of identification of patients with non-SLN metastases (NRI: 0.121; 95% CI: 0.081–0.202; P = 0.011 ). Conclusions. This novel nomogram based on preoperative serum indexes combined with clinicopathologic features facilitates accurate prediction of risk of non-SLN metastases in Chinese patients with breast cancer.

Predicting non-sentinel lymph node involvement in breast cancer patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 531-531
Author(s):  
H. E. Kohrt ◽  
R. A. Olshen ◽  
W. H. Goodson ◽  
R. V. Rouse ◽  
L. Bailey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Tumor Size ◽  
Recursive Partitioning ◽  
Positive Sentinel Lymph Node ◽  
Lymph Node Involvement ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Clinicopathologic Characteristics

531 Background: Current convention is to perform a completion axillary lymph node dissection (ALND) for invasive breast cancer (BC) patients (pts) with positive sentinel lymph node(s) (+SLN), even though <50% will have non-sentinel lymph node metastasis (+NSLN). Our goal was to develop and compare predictive models of NSLN status among +SLN pts to identify for whom completion ALND may be omitted. Methods: We constructed 3 models by recursive partitioning with receiver-operating-characteristic curves (RP-ROC), boosted classification and regression trees (CART), and a multivariate logistic regression (MLR) informed by CART. Models were developed using a multi-institutional database of 1,040 BC pts who underwent SLN biopsy and completion ALND at academic or community hospitals as part of a prospective, consented study. Accuracies were compared to the Memorial Sloan-Kettering Breast Cancer Nomogram (Nomogram). Results: 976 BC pts had evaluable SLNs and 285 had +SLNs; 101(35.4%) +SLN pts had +NSLNs. Tumor size, lymphovascular invasion (LVI), and SLN metastasis size were the best predictors of risk (multivariate P-values<0.001) of +NSLN. 39 of 156 +SLN pts (25%) with T1 tumors had +NSLNs vs. 62 of 129 (48%) with T2/T3 tumors. 73.7% with LVI vs 19.5% without LVI had +NSLNs. 4.7% of pts with isolated tumor cells, 42% with micrometastasis and 71% with macrometastasis in SLN had +NSLNs. MLR informed by CART identified 2 highly predictive variables, the LVI × size of SLN metastasis [OR 4.73(3.11–7.20, 95%CI), P<0.001] and tumor size × size of SLN metastasis [OR 1.18(1.10–1.26, 95%CI), P<0.001]. While RP-ROC and boosted CART stratified pts into low-risk (4.3%-9.9%), moderate-risk (33.3%-42.9%), and high-risk (62.2%-93%) groups, MLR predicted NSLN status with accuracy superior to RP-ROC, boosted CART, and the Nomogram: 83.3%, 76.7%, 67.7%, and 76.7%, respectively, after 10-fold cross validation. The Nomogram’s sensitivity was significantly inferior to those of RP-ROC, boosted CART, and MLR: 53.8%, 78.8%, 78.2%, and 78.0%, respectively. Conclusions: In pts with +SLNs, interactions between clinicopathologic characteristics are highly informative in predicting risk of +NSLN. However, neither our methods nor the Nomogram achieved sufficient accuracy to recommend a change in current clinical practice. No significant financial relationships to disclose.

IV-DSA is a new diagnostic tool for axillary lymph node metastasis in breast cancer patients

2004 ◽  
Vol 87 (2) ◽  
pp. 75-79 ◽  
Author(s):  
Osamu Watanabe ◽  
Tadao Shimizu ◽  
Hiroshi Imamura ◽  
Jun Kinoshita ◽  
Yoshihito Utada ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Diagnostic Tool ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Metastasis
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