Nomogram including the total tumoral load in the sentinel nodes assessed by one-step nucleic acid amplification as a new factor for predicting nonsentinel lymph node metastasis in breast cancer patients
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Several models have been developed to predict non-sentinel nodes (NSLN) metastasis in patients with a positive sentinel node (SLN) that incorporates a standard pathology examination of the SLN. It has been reported that total tumoral load (TTL) in the SLNs assessed by one-step nucleic acid amplification (OSNA) is a predictive factor for additional NSLN metastasis in the axillary lymph node dissection (ALND). The objective was to develop a nomogram that predicts patient´s risk of additional NSLN metastasis incorporating TTL in the SLNs assessed by OSNA. Six hundred and ninety-seven consecutive patients with positive SLN evaluation by OSNA and a completion ALND were recruited. Pathologic features of the primary tumor and SLN metastases, including TTL were collected. Multivariate logistic regression identified factors predictive of non-SLN metastasis. A nomogram was developed with these variables and validated in an external cohort. On multivariate logistic regression analysis, tumor size, number of affected SLN, Her2 overexpression, lymphovascular invasion, and TTL were each associated with the likelihood of additional NSLN metastasis (p < 0.05). The overall predictive accuracy of the nomogram, as measured by the AUC was 0.7552 (95 %CI 0.7159–0.7945). When applied to the external cohort the nomogram was accurate with an AUC = 0.678 (95 %CI 0.621–0.736). This novel nomogram that incorporates TTL assessed by OSNA performs well and may help clinicians to make decisions about ALND for individual patients. Moreover, the standardization of pathologic assessment by OSNA may help to achieve interinstitutional reproducibility among nomograms.
KeywordsTotal tumoral load Sentinel lymph node Prediction
This study was supported by a grant from the Sysmex Espana S.L. The sponsor had no role in the study design, analysis, or interpretation of the data.
- 1.Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Constantino JP et al (2010) Sentinel lymph node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11(10):927–933PubMedCentralPubMedCrossRefGoogle Scholar
- 6.Giuliano AE, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM et al (2010) Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastasis: the American College of Surgeons Oncology group z0011 randomized trial. Ann Surg 252:426–432PubMedGoogle Scholar
- 13.Mittendorf EA, Hunt KK, Boughey JC, Bassett R, Degnim AC, Harrell R et al (2012) Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg 255:109–115PubMedCrossRefGoogle Scholar
- 17.Castellano I, Macri L, Deambrogio C, Balmativola D, Bussone R, Ala A et al (2011) Reliability of whole sentinel lymph node analysis by one-step nucleic acid amplification for intraoperative diagnosis of breast cancer metastases. Ann Surg 00:1–9Google Scholar
- 25.Edge SBBD, Compton CC, Fritz AG et al (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
- 31.Van Calster B, Vanden Bempt I, Drijkoningen M, Pochet N, Cheng J, Van Huffel S et al (2009) Axillary lymph node status of operable breast càncers by combined steroid receptor and Her2 status: triple positive tumors are more likely lymph node positive. Breast Cancer Res Treat 113:181–187PubMedCrossRefGoogle Scholar
- 41.Caudle A, Hunt KK, Kuerer HM, Meric-Berstein F, Lucci A, Bedrosian I, Babiera GV et al (2011) Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol 18(9):2407–2412PubMedCrossRefGoogle Scholar