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Objective:To explore the relationship between lymphovascular invasion and non-sentinel lymph node (NSLN) metastasis in early-stage invasive breast cancer with positive sentinel lymph node (SLN) and its significance.Methods:The clinicopathological data of 79 patients with stage cT 1-2N 0M 0 invasive breast cancer who had positive SLN by biopsy and underwent axillary lymph node dissection (ALND) from January 2015 to February 2021 in the Central Hospital of Wuhan were retrospectively analyzed. The correlation between patients' clinicopathological characteristics and NSLN metastasis was analyzed. Results:Among 79 patients, 58 patients (73.4%) underwent total mastectomy, 61 patients (77.2%) were Luminal type, 38 patients (48.1%) had lymphovascular invasion, 64 patients (81.0%) had 1-2 positive SLN, and 42 patients (53.2%) with NSLN metastasis were found after ALND. Univariate analysis showed that the proportions of patients with lymphovascular invasion diagnosed by immunohistochemistry [86.8% (33/38) vs. 51.2% (21/41)], Ki-67 positive index>30% [60.5% (23/38) vs. 36.6% (15/41)], positive human epidermal growth factor receptor 2 [36.8% (14/38) vs. 14.6% (6/41)], and elevated lymph node pathological staging [57.9% (22/38) vs. 31.7% (13/41)] in the lymphovascular invasion group were higher than those in the non-lymphovascular invasion group (all P < 0.05). Multivariate logistic regression analysis showed that lymphovascular invasion was an independent risk factor for NSLN metastasis ( OR = 2.935, 95% CI 1.081-7.970, P = 0.035). Conclusions:Lymphovascular invasion is an independent risk factor for NSLN metastasis in SLN-positive stage cT 1-2N 0M 0 invasive breast cancer. It may help to guide the decision-making of local axillary treatment, so as to avoid over or under treatment.
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Objective To investigate the effect of the number of sentinel lymph node (SLN) dissection on prediction of non-sentinel lymph node (nSLN) metastasis in SLN biopsy in patients with early-stage breast cancer. Methods A retrospective analysis of clinical and pathological data of 82 patients with early-stage breast cancer who underwent SLN biopsy and axillary lymph node dissection in the Affiliated Cancer Hospital of Shanxi Medical University from January 2015 to December 2016 was conducted, and the univariate analysis and logistic multivariate regression analysis were performed to analyze the influencing factors of nSLN metastasis. Results Univariate analysis showed that nSLN metastasis was associated with histological grade (χ2 = 10.114, P= 0.006), vascular invasion (χ2 = 12.381, P< 0.01), and the number of positive SLN ≥2 (χ2=13.734, P<0.01), however, it was not related to patient's age, tumor size, SLN metastasis rate, molecular subtype and pathological type (all P>0.05). Multivariate analysis showed that the number of positive SLN≥2 was an independent influencing factor of nSLN metastasis (OR= 4.145, P= 0.015). Conclusions Surgeons need to ensure that the number of SLN dissection is > 2 when the SLN biopsy is performed in patients with breast cancer. When the number of positive SLN is≥2, the risk of nSLN metastasis increases.
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Objective To evaluate the risk factors of non-sentinel lymph node (NSLN) metastasis in breast cancer patients with 1-2 positive sentinel lymph nodes and to establish a new Nomogram prediction model.Methods Clinicopathological data of breast cancer patients who were diagnosed with 1-2 positive lymph nodes and underwent axillary lymph node dissection (ALND) without neoadjuvant chemotherapy from January 2008 to December 2014 were retrospectively analyzed.Measurement data between two groups were analyzed by chi-square test.Multivariate analysis was performed by logistic regression model.The prediction accuracy of the Nomogram model was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves.Results A total of 270 patients were recruited in this study.Among them,87(32.2％) patients had NSLN metastases.The median age was 46 years old (21-80 years),the median number of SLNs was 4 (1-10) and the median number of axillary lymph nodes was 20(10-41).Univariate analysis demonstrated that the pathological grade,the size of SLN metastasis,the number of negative and positive SLNs were the risk factors of NSLN metastasis (P=0.001-0.045).Multivariate analysis showed that pathological grade,the number of negative and positive SLNs were independent risk factors of NSLN metastasis (P=0.000-0.041).The AUC value of Nomogram prediction model for NSLN metastasis was 0.70.The false negative rate of Nomogram was 10.5％ when the cut-off point of predictive probability was ≤ 15％.Conclusions The Nomogram is a useful prediction model for evaluating NSLN metastasis.ALND or axillary radiotherapy can be avoided for patients with a low probability of NSLN metastasis.
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Objective To analyze the relationship between non-sentinel lymph node ( NSLN ) metastases and clinicopathologic features in breast invasive ductal carcinoma patients with 1, 2 positive sentinel lymph node(SLN). Methods A total of one hundred and ninety-eight patients with breast invasive ductal carcinoma from January 2013 to December 2017 were enrolled in this prospective study. Modified radical mastectomy was performed after SLN1-2 positive cases were confirmed by biopsy. Postoperative NSLN was counted and the relationship between NSLN and clinical factors was analyzed. Results The positive rate of NSLN in 198 patients was 40. 9%(81/198),of which 80 cases were positive at axillary level I and only 1 case was positive at axillary level I and II. There was no significant correlation between NSLN positive and age (χ2＝1. 258),lesion grade (χ2＝1. 327),molecular typing (χ2＝1. 020),neoadjuvant chemotherapy (χ2＝0. 923),estrogen receptor (χ2＝0. 189),progesterone receptor ( χ2＝0. 109),Ki67 ( χ2＝1. 755) ( P＞0. 05). The positive rate of NSLN in HER-2 positive patients was 56. 9%(29/51),which was significantly higher than 35.4%(52/147) in HER-2 negative patients (χ2 ＝6.136,P＝0.034).Logistic regression analysis showed that HER-2 positive was an independent risk factor for NSLN ( OR＝0. 031,95%CI 0. 012－0. 615,P＝0. 022) . Conclusion The risk of NSLN positive in breast cancer patients such as SLN1-2 positive patients is still high,and the risk of NSLN positive in HER-2 positive patients is higher.
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Objective:The study aimed to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stan-ford Online Calculator (SOC) prediction of non-sentinel lymph node (NSLN) metastasis in Chinese patients with sentinel lymph node (SLN)-positive breast cancers. Methods:The MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients who were positive for SLNs. The area under the receiver operating characteristic curves (AUC) for each model was evaluated. Patients with 10%and 90%probabilities of NSLN metastasis were separately examined. Results:The MSKCC and SOC predicted the likelihood of NSLN metastasis in a consecutive group of 120 patients with AUCs of 0.688 and 0.734, respective-ly. At the lowest probability cutoff value of 10%, the false-negative rates of MSKCC and SOC were both 4.4%, and the negative predic-tive values were 75.0%and 90.0%, respectively. When the highest probability cutoff value of 90%was used, the false-positive rates were 0.0%and 6.7%, and the positive predictive values were 100.0%and 68.8%, respectively. Conclusion:Results of the MSKCC no-mogram and SOC were inferior to those of previous studies on predicting NSLN metastasis in Chinese patients with breast cancers. The prediction ability of SOC was slightly superior to that of the MSKCC nomogram.
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Breast cancer is the leading cause of malignancy-related mortality in women worldwide. The more accurate prediction of lymph node metastasis and evaluation of personalized prognosis of breast cancer patients could provide evidence and reference for individualized comprehensive treatment and clinical decision-making. Nomogram is statistical calculation model developed to generate individualized prediction of a certain clinical event through the factors associated with it. Currently breast cancer related nomogram models is most commonly used in the prediction of non-sentinel lymph node status in patients with sentinel lymph node-positive breast cancer, sentinel lymph node metastasis in clinical node-negative breast cancer and prognosis evaluation of breast cancer. This article reviewed the recent advances in breast cancer related nomograms according to the above mentioned three aspects, and evaluated respectively the predictive factors, accuracy, characteristics and clinical application potential.