Breast Cancer Research and Treatment

, Volume 147, Issue 2, pp 371–380 | Cite as

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

  • Isabel T. Rubio
  • Martin Espinosa-Bravo
  • Maxi Rodrigo
  • Maria Amparo Viguri Diaz
  • David Hardisson
  • Amaia Sagasta
  • Basilio Dueñas
  • Vicente Peg
Clinical trial


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.


Total 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.




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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Isabel T. Rubio
    • 1
  • Martin Espinosa-Bravo
    • 1
  • Maxi Rodrigo
    • 2
  • Maria Amparo Viguri Diaz
    • 3
  • David Hardisson
    • 4
  • Amaia Sagasta
    • 5
  • Basilio Dueñas
    • 6
  • Vicente Peg
    • 7
    • 8
  1. 1.Breast Surgical Oncology Unit, Hospital Universitario Vall d´Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Department of PathologyHospital General YagüeBurgosSpain
  3. 3.Department of PathologyHUA TxagorritxuVitoriaSpain
  4. 4.Department of Pathology, Faculty of Medicine, IdiPAZ (Hospital La Paz Institute for Health Research), University Hospital La PazUniversidad Autónoma de MadridMadridSpain
  5. 5.Department of PathologyHospital ClinicBarcelonaSpain
  6. 6.Department of SurgeryComplejo Hospitalario de JaenJaenSpain
  7. 7.Department of Pathology, Hospital Universitario Vall d´HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
  8. 8.Morphological Sciences DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain

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