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A Scoring System to Predict Nonsentinel Lymph Node Status in Breast Cancer Patients with Metastatic Sentinel Lymph Nodes: A Comparison with Other Scoring Systems

¹ Department of Surgery, Keimyung University College of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
² Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
³ Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-744, Korea
⁴ Department of Diagnostic Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, Korea
⁵ Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, Korea
⁶ Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, Korea

Correspondence: Address correspondence and reprint requests to: Dong-Young Noh, MD, PhD; E-mail: chojh0404{at}medimail.co.kr

Background: The majority of breast cancer patients with metastatic sentinel lymph node (SLN) do not harbor additional metastasis in non-SLN. It is unclear which patients with metastatic SLN require axillary lymph node dissection (ALND). The aim of this study was to identify predictive factors of non-SLN metastasis and to develop a scoring system.

Methods: The training dataset consisted of 184 breast cancer patients. The independent validation dataset consisted of 82 breast cancer patients. The receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems.

Results: Multivariate analysis revealed that non-SLN status was predicted by preoperative ultrasonographic findings of the axilla, lymphovascular invasion, increasing tumor size, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Based on multivariate logistic regression, we developed a scoring system for predicting non-SLN metastasis. The AUC for our scoring system was superior to other published scoring systems when identical validation data were applied.

Conclusion: The likelihood of metastatic non-SLN correlated with preoperative ultrasonographic findings of the axilla, increasing pathologic size of the primary tumor, presence of lymphovascular invasion, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Our scoring system appears to be effective and accurate for selecting patients for whom ALND can be avoided.

Key Words: Breast cancer • Sentinel lymph node biopsy • Axillary lymph node dissection • Nonsentinel lymph node metastasis • Prediction • Scoring system

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