Skip to main content

Advertisement

SpringerLink
Log in

A Predictive Tool to Estimate the Risk of Axillary Metastases in Breast Cancer Patients with Negative Axillary Ultrasound

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

Abstract

Background

Sentinel node biopsy (SNB) is the “gold standard” in axillary staging in clinically node-negative breast cancer patients. However, axillary treatment is undergoing a paradigm shift and studies are being conducted on whether SNB may be omitted in low-risk patients. The purpose of this study was to evaluate the risk factors for axillary metastases in breast cancer patients with negative preoperative axillary ultrasound.

Methods

A total of 1,395 consecutive patients with invasive breast cancer and SNB formed the original patient series. A univariate analysis was conducted to assess risk factors for axillary metastases. Binary logistic regression analysis was conducted to form a predictive model based on the risk factors. The predictive model was first validated internally in a patient series of 566 further patients and then externally in a patient series of 2,463 patients from four other centers. All statistical tests were two-sided.

Results

A total of 426 of the 1,395 (30.5 %) patients in the original patient series had axillary lymph node metastases. Histological size (P < 0.001), multifocality (P < 0.001), lymphovascular invasion (P < 0.001), and palpability of the primary tumor (P < 0.001) were included in the predictive model. Internal validation of the model produced an area under the receiver operating characteristics curve (AUC) of 0.731 and external validation an AUC of 0.79.

Conclusions

We present a predictive model to assess the patient-specific probability of axillary lymph node metastases in patients with clinically node-negative breast cancer. The model performs well in internal and external validation. The model needs to be validated in each center before application to clinical use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Veronesi U, Orecchia R, Zurrida S, et al. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy. Ann Oncol. 2005;16(3):383–8.

    Article  CAS  PubMed  Google Scholar 

  2. Rudenstam CM, Zahrieh D, Forbes JF, et al. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93. J Clin Oncol. 2006;24(3):337–44.

    Article  PubMed  Google Scholar 

  3. Martelli G, Boracchi P, Ardoino I, Lozza L, Bohm S, Vetrella G, Agresti S. Axillary dissection versus no axillary dissection in older patients with T1N0 breast cancer: 15-year results of a randomized controlled trial. Ann Surg. 2012;256(6):920–4.

    Article  PubMed  Google Scholar 

  4. Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8.

    Article  PubMed Central  PubMed  Google Scholar 

  5. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol. 2008;26(32):5220–6.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302(18):1985–92.

    Article  PubMed  Google Scholar 

  7. Diepstraten S, Sever A, Buckens C, et al. Value of preoperative ultrasound-guided axillary lymph node biopsy for preventing completion axillary lymph node dissection in breast cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2014;21(1):51–9.

    Article  PubMed  Google Scholar 

  8. Gentilini O, Veronesi U. Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology of Milan (SOUND: Sentinel node vs Observation after axillary UltraSouND). Breast. 2012;21(5):678–81.

    Article  PubMed  Google Scholar 

  9. Meretoja TJ, Leidenius MH, Heikkila PS, Joensuu H. Sentinel node biopsy in breast cancer patients with large or multifocal tumors. Ann Surg Oncol. 2009;16(5):1148–55.

    Article  PubMed  Google Scholar 

  10. Meretoja TJ, Strien L, Heikkilä PS, Leidenius MH. A simple nomogram to evaluate the risk of nonsentinel node metastases in breast cancer patients with minimal sentinel node involvement. Ann Surg Oncol. 2012;19(2):567–76.

    Article  CAS  PubMed  Google Scholar 

  11. Sørlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001;98(19):10869–74.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Cheang MC, Chia SK, Voduc D, et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009;101(10):736–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Viale G, Zurrida S, Maiorano E, et al. Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution. Cancer. 2005;103(3):492–500.

    Article  PubMed  Google Scholar 

  14. Bevilacqua JL, Kattan MW, Fey JV, Cody HS, Borgen PI, Van Zee KJ. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol. 2007;25(24):3670–9.

    Article  PubMed  Google Scholar 

  15. Reyal F, Rouzier R, Depont-Hazelzet B, et al. The molecular subtype classification is a determinant of sentinel node positivity in early breast carcinoma. PLoS One. 2011;6(5):e20297.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Leidenius MH, Vironen JH, von Smitten KA, Heikkilä PS, Joensuu H. The outcome of sentinel node biopsy in breast cancer patients with preoperative surgical biopsy. J Surg Oncol. 2009;99(7):420–3.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Funding

The first author of this study was supported by grants from the Academy of Finland, Orion-Farmos Research Foundation, Emil Aaltonen’s Foundation, and Maud Kuistila Memorial Foundation. The funders did not have any involvement in the design of the study, the collection, analysis, and interpretation of the data, the writing of the article, or the decision to submit the article for publication.

Disclosure

The authors have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland

    T. J. Meretoja MD, PhD, A. S. Mansfield MD & M. H. K. Leidenius MD, PhD

  2. Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland

    P. S. Heikkilä MD, PhD

  3. Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    G. Cserni MD, DSc, PhD

  4. Department of Pathology, University of Szeged, Szeged, Hungary

    G. Cserni MD, DSc, PhD

  5. Department of Radiology, Mamma ZRT, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    E. Ambrozay MD

  6. Department of Surgery, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary

    G. Boross MD

  7. Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia

    J. Zgajnar MD, PhD & A. Perhavec MD, PhD

  8. Department of Pathology, Institute of Oncology, Ljubljana, Slovenia

    B. Gazic MD

  9. Department of Pathology, A.O. Citta’ della salute e della scienza-Sant‘Anna Hospital, Turin, Italy

    R. Arisio MD, PhD

  10. Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark

    T. F. Tvedskov MD, PhD

  11. Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark

    M.-B. Jensen MSc

Authors
  1. T. J. Meretoja MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. S. Heikkilä MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. S. Mansfield MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Cserni MD, DSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Ambrozay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Boross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Zgajnar MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Perhavec MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B. Gazic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R. Arisio MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. T. F. Tvedskov MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M.-B. Jensen MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. H. K. Leidenius MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. J. Meretoja MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLS 30 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meretoja, T.J., Heikkilä, P.S., Mansfield, A.S. et al. A Predictive Tool to Estimate the Risk of Axillary Metastases in Breast Cancer Patients with Negative Axillary Ultrasound. Ann Surg Oncol 21, 2229–2236 (2014). https://doi.org/10.1245/s10434-014-3617-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3617-6

Keywords

Search

Navigation