Annals of Surgical Oncology

, Volume 15, Issue 8, pp 2278–2286 | Cite as

A Scoring System to Predict Nonsentinel Lymph Node Status in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes: A Comparison with Other Scoring Systems

  • Jihyoung Cho
  • Wonshik Han
  • Jong Won Lee
  • Eunyoung Ko
  • So Young Kang
  • So-Youn Jung
  • Eun-Kyu Kim
  • Woo Kyung Moon
  • Nariya Cho
  • In-Ae Park
  • Jun-Key Chung
  • Ki-Tae Hwang
  • Sung-Won Kim
  • Dong-Young Noh
Breast Oncology



The majority of breast cancer patients with metastatic sentinel lymph node (SLN) do not harbor additional metastasis in non-SLN. It is unclear which patients with metastatic SLN require axillary lymph node dissection (ALND). The aim of this study was to identify predictive factors of non-SLN metastasis and to develop a scoring system.


The training dataset consisted of 184 breast cancer patients. The independent validation dataset consisted of 82 breast cancer patients. The receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems.


Multivariate analysis revealed that non-SLN status was predicted by preoperative ultrasonographic findings of the axilla, lymphovascular invasion, increasing tumor size, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Based on multivariate logistic regression, we developed a scoring system for predicting non-SLN metastasis. The AUC for our scoring system was superior to other published scoring systems when identical validation data were applied.


The likelihood of metastatic non-SLN correlated with preoperative ultrasonographic findings of the axilla, increasing pathologic size of the primary tumor, presence of lymphovascular invasion, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Our scoring system appears to be effective and accurate for selecting patients for whom ALND can be avoided.


Breast cancer Sentinel lymph node biopsy Axillary lymph node dissection Nonsentinel lymph node metastasis Prediction Scoring system 



This work was supported by a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, R.O.K (01-PJ3-PG6-01GN07-0004).

Conflict of Interest Statement

The authors declare that they have no competing interests.


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Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Jihyoung Cho
    • 1
  • Wonshik Han
    • 2
    • 3
  • Jong Won Lee
    • 2
  • Eunyoung Ko
    • 2
  • So Young Kang
    • 3
  • So-Youn Jung
    • 2
  • Eun-Kyu Kim
    • 2
  • Woo Kyung Moon
    • 4
  • Nariya Cho
    • 4
  • In-Ae Park
    • 5
  • Jun-Key Chung
    • 6
  • Ki-Tae Hwang
    • 2
  • Sung-Won Kim
    • 2
  • Dong-Young Noh
    • 2
    • 3
  1. 1.Department of SurgeryKeimyung University College of Medicine, Dongsan Medical CenterDaeguKorea
  2. 2.Department of SurgerySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
  3. 3.Cancer Research InstituteSeoul National University College of MedicineSeoulKorea
  4. 4.Department of Diagnostic RadiologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
  5. 5.Department of PathologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
  6. 6.Department of Nuclear MedicineSeoul National University College of Medicine, Seoul National University HospitalSeoulKorea

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