Breast Cancer Research and Treatment

, Volume 91, Issue 2, pp 113–119 | Cite as

An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement

  • Emmanuel BarrangerEmail author
  • Charles Coutant
  • Antoine Flahault
  • Yann Delpech
  • Emile Darai
  • Serge Uzan


Background. Axillary lymph node dissection (ALND) is the current standard of care for breast cancer patients with sentinel lymph node (SN) involvement. However, the SN is the only involved axillary node in a significant proportion of these patients. Here we examined factors predictive of non-SN involvement in patients with a metastatic SN, in order to develop a scoring system for predicting non-SN involvement.

Materials and Methods. This study was based on a prospective database of 337 patients who underwent SN biopsy for breast cancer, of whom 81 (24) were SN-positive; we examined factors predictive of non SN involvement in the 71 of these 81 women who underwent complementary ALND. All clinical and histological criteria were recorded and analysed according to non-SN status, by using Chi-2 analysis, Student’s t-test, and multivariate logistic regression.

Results. Univariate analysis showed a significant association between non-SN involvement and histological primary tumor size (p=0.0001), SN macrometastasis (p=0.01), the method used to detect SN metastasis (H&E versus immunohistochemistry) (p=0.03), the number of positive SNs (p=0.049), the proportion of involved SNs among all identified SNs (p=0.0001) and lymphovascular invasion (p=0.006). Histological primary tumor size (p=0.006), SN macrometastasis (p=0.02) and the proportion of involved SNs among all identified SNs (p=0.03) remained significantly associated with non-SN status in multivariate analysis. Based on the multivariate analysis, we developed an axilla scoring system (range 0–7) to predict the likelihood of non-SN metastasis in breast cancer patients with SN involvement.

Conclusion. In patients with invasive breast cancer and a positive SN, histological primary tumor size, the size of SN metastases, and the proportion of involved SNs among all identified SNs were independently predictive of non-SN involvement.


axilla scoring system breast cancer non-sentinel lymph node metastasis prediction sentinel lymph node 


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  1. 1.
    Carter, CL, Allen, C, Henson, DE 1989Relation of tumor size, lymph node status, and survival in 24,740 breast cancer casesCancer63181187PubMedGoogle Scholar
  2. 2.
    Hoe, AL, Iven, D, Royle, GT, Taylor, I 1992Incidence of arm swelling following axillary clearance for breast cancerBr J Surg79261262PubMedGoogle Scholar
  3. 3.
    Krag, DN, Weaver, DL, Alex, JC, Fairbank, JT 1993Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probeSurg Oncol2335340CrossRefPubMedGoogle Scholar
  4. 4.
    Giuliano, AE, Kirgan, DM, Guenther, JM, Morton, DL 1994Lymphatic mapping and sentinel lymphadenectomy for breast cancerAnn Surg220391401PubMedGoogle Scholar
  5. 5.
    Chu, KU, Turner, RR, Hansen, NM, Brennan, MB, Giuliano, AE 1999Sentinel node metastasis in patients with breast carcinoma accurately predicts immunohistochemically detec table nonsentinel node metastasisAnn Surg Oncol6756761CrossRefPubMedGoogle Scholar
  6. 6.
    Kamath, VJ, Giuliano, R, Dauway, EL,  et al. 2001Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissectionArch Surg136688692CrossRefPubMedGoogle Scholar
  7. 7.
    Sachdev, U, Murphy, K, Derzie, A,  et al. 2002Predictors of non-sentinel lymph node metastasis in breast cancer patientsAm J Surg183213217CrossRefPubMedGoogle Scholar
  8. 8.
    Stitzenberg, KB, Meyer, AA, Stern, SL,  et al. 2003Extracapsular extension of the sentinel lymph node metastasis: a predictor of nonsentinel node tumor burdenAnn Surg237607612CrossRefPubMedGoogle Scholar
  9. 9.
    Fisher, B, Redmond, C, Fisher, ER,  et al. 1988Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiationN Engl J Med312674681CrossRefGoogle Scholar
  10. 10.
    Chu, KU, Turner, RR, Hansen, NM,  et al. 1999Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection?Ann Surg229536541CrossRefPubMedGoogle Scholar
  11. 11.
    Van Zee, KJ, Manasseh, DME, Bevilacqua, JLB,  et al. 2003A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsyAnn Surg Oncol1011401151CrossRefPubMedGoogle Scholar
  12. 12.
    Saidi, RF, Dubrick, PS, Remine, SG, Mittal, VK 2004Nonsentinel lymph node status after positive sentinel lymph node biopsy in early breast cancerAm Surg70101105PubMedGoogle Scholar
  13. 13.
    Travagli, JP, Atallah, D, Mathieu, MC,  et al. 2003Sentinel lymphadenectomy without systematic axxilary dissection in breast cancer patients: predictors of non-sentinel lymph node metastasisEur J Surg Oncol29403406CrossRefPubMedGoogle Scholar
  14. 14.
    Reynolds, C, Mick, R, Donohue, JH,  et al. 1999Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer?J Clin Oncol1717201726PubMedGoogle Scholar
  15. 15.
    Turner, RR, Chu, KU, Qi, K,  et al. 2000Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph nodeCancer89574581CrossRefPubMedGoogle Scholar
  16. 16.
    Viale, G, Maiorano, E, Mazzarol, G,  et al. 2001Histologic detection and clinical implications of micrometastases in axillary sentinel lymph nodes for patients with breast carcinomaCancer9213781384CrossRefPubMedGoogle Scholar
  17. 17.
    Weiser, MR, Montgomery, LL, Tan, LK,  et al. 2001Lymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodesAnn Surg Oncol8145149PubMedGoogle Scholar
  18. 18.
    Wong, SL, Edwards, MJ, Chao, C,  et al. 2001University of Louisville Breast Cancer Sentinel Lymph Node Study Group. Predicting the status of the nonsentinel axillary nodes: a multicenter studyArch Surg136563568CrossRefPubMedGoogle Scholar
  19. 19.
    Nos, C, Harding-MacKean, C, Freneaux, P,  et al. 2003Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastasesBr J Surg9013541360CrossRefPubMedGoogle Scholar
  20. 20.
    Iterson, V, Leidenius, M, Krogerus, L, Smitten, K. 2003Predictive factors for the status of non-sentinel nodes in breast cancer patients with tumor positive sentinel nodesBreast Cancer Res Treat823945CrossRefPubMedGoogle Scholar
  21. 21.
    Fournier, K, Schiller, A, Perry, RR, Laronga, C 2004Micrometastasis in the sentinel lymph node of breast cancer does not mandate completion axillary dissectionAnn Surg239859865CrossRefPubMedGoogle Scholar
  22. 22.
    Fleming, FJ, Kavanagh, D, Crotty, TB,  et al. 2004Factors affecting metastases to non-sentinel lymph nodes in breast cancerJ Clin Pathol577376CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Emmanuel Barranger
    • 1
    Email author
  • Charles Coutant
    • 1
  • Antoine Flahault
    • 2
  • Yann Delpech
    • 1
  • Emile Darai
    • 1
  • Serge Uzan
    • 1
  1. 1.Department of Gynecologic and Breast cancersHôpital TenonParisFrance
  2. 2.Department of StatisticHôpital TenonParisFrance

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