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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Surgery, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, 700-712, Korea

    Jihyoung Cho MD

  2. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Wonshik Han MD, PhD, Jong Won Lee MD, Eunyoung Ko MD, So-Youn Jung MD, Eun-Kyu Kim MD, Ki-Tae Hwang MD, PhD, Sung-Won Kim MD, PhD & Dong-Young Noh MD, PhD

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-744, Korea

    Wonshik Han MD, PhD, So Young Kang PhD & Dong-Young Noh MD, PhD

  4. Department of Diagnostic Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 110-744, Korea

    Woo Kyung Moon MD, PhD & Nariya Cho MD, PhD

  5. Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 110-744, Korea

    In-Ae Park MD, PhD

  6. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 110-744, Korea

    Jun-Key Chung MD, PhD

Authors
  1. Jihyoung Cho MD
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  2. Wonshik Han MD, PhD
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Corresponding author

Correspondence to Dong-Young Noh MD, PhD.

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Cho, J., Han, W., Lee, J.W. et al. A Scoring System to Predict Nonsentinel Lymph Node Status in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes: A Comparison with Other Scoring Systems. Ann Surg Oncol 15, 2278–2286 (2008). https://doi.org/10.1245/s10434-008-9993-z

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  • DOI: https://doi.org/10.1245/s10434-008-9993-z

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