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Multi-Institutional Comparison of Non-sentinel Lymph Node Predictive Tools in Breast Cancer Patients with High Predicted Risk of Further Axillary Metastasis

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Pathology & Oncology Research

Abstract

Although axillary lymph node dissection (ALND) has been the standard intervention in breast cancer patients with sentinel lymph node (SLN) metastasis, only a small proportion of patients benefit from this operation, because most do not harbor additional metastases in the axilla. Several predictive tools have been constructed to identify patients with low risk of non-SLN metastasis who could be candidates for the omission of ALND. In the present work, predictive nomograms were used to predict a high (>50 %) risk of non-SLN metastasis in order to identify patients who would most probably benefit from further axillary treatment. Data of 1000 breast cancer patients with SLN metastasis and completion ALND from 5 institutions were tested in 4 nomograms. A subset of 313 patients with micrometastatic SLNs were also tested in 3 different nomograms devised for the micrometastatic population (the high risk cut-off being 20 %). Patients with a high predicted risk of non-SLN metastasis had higher rates of metastasis in the non-SLNs than patients with low predicted risk. The positive predictive values of the nomograms ranged from 44 % to 64 % with relevant inter-institutional variability. The nomograms for micrometastatic SLNs performed much better in identifying patients with low risk of non-SLN involvement than in high-risk-patients; for the latter, the positive predictive values ranged from 13 % to 20 %. The nomograms show inter-institutional differences in their predictive values and behave differently in different settings. They are worse in identifying high risk patients than low-risk ones, creating a need for new predictive models to identify high-risk patients.

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Authors and Affiliations

  1. Department of Pathology, University of Szeged, Állomás u. 2., 6720, Szeged, Hungary

    Gábor Cserni & András Vörös

  2. Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyiri ut 38, 6000, Kecskemét, Hungary

    Gábor Cserni & Rita Bori

  3. Department of Surgery, Bács-Kiskun County Teaching Hospital, Nyiri ut 38, 6000, Kecskemét, Hungary

    Róbert Maráz

  4. Breast Surgery Unit, Helsinki University Central Hospital, P.O. Box 140, Helsinki, 00029, Finland

    Marjut H. K. Leidenius & Tuomo J. Meretoja

  5. Department of Pathology, Helsinki University Central Hospital, P.O. Box 400, Helsinki, 00029, Finland

    Paivi S. Heikkila

  6. Department of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria

    Peter Regitnig

  7. Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria

    Gero Luschin-Ebengreuth

  8. Department of Surgical Oncology, Institute of Oncology, Zaloska c. 2, 1105, Ljubljana, Slovenia

    Janez Zgajnar & Andraz Perhavec

  9. Department of Pathology, Institute of Oncology, Zaloska c. 2, 1105, Ljubljana, Slovenia

    Barbara Gazic

  10. Department of Surgery, University of Szeged, Pecsi u 6, 6720, Szeged, Hungary

    György Lázár & Tibor Takács

  11. Department of Surgery, St Helens Teaching Hospital, Marshalls Cross Road, WA93DA, St Helens, UK

    Riccardo A. Audisio

Authors
  1. Gábor Cserni
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  2. Rita Bori
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  3. Róbert Maráz
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  4. Marjut H. K. Leidenius
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  5. Tuomo J. Meretoja
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  6. Paivi S. Heikkila
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  7. Peter Regitnig
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  8. Gero Luschin-Ebengreuth
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  9. Janez Zgajnar
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  10. Andraz Perhavec
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  11. Barbara Gazic
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  12. György Lázár
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  13. Tibor Takács
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  14. András Vörös
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  15. Riccardo A. Audisio
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Corresponding author

Correspondence to Gábor Cserni.

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Cserni, G., Bori, R., Maráz, R. et al. Multi-Institutional Comparison of Non-sentinel Lymph Node Predictive Tools in Breast Cancer Patients with High Predicted Risk of Further Axillary Metastasis. Pathol. Oncol. Res. 19, 95–101 (2013). https://doi.org/10.1007/s12253-012-9553-5

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  • DOI: https://doi.org/10.1007/s12253-012-9553-5

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