Prediction of Non-Sentinel Node Metastasis in Breast
Cancer - A Population-Based Study

Eva Vikhe Patil; Ivan Shabo; Oliver Gimm; Lars-Gunnar Arnesson; Helena Fohlin

Mini Review

Prediction of Non-Sentinel Node Metastasis in Breast Cancer - A Population-Based Study

Eva Vikhe Patil¹*, Ivan Shabo^2,3, Oliver Gimm¹, Lars-Gunnar Arnesson¹ and Helena Fohlin⁴

¹Department of Surgery and Department of Biomedical and Clinical Sciences, Linkö-ping University, SE-581 83 Linköping, Sweden

²Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm SE-171 77 Sweden

³Department of Breast Cancer, Sarcoma and Endocrine Tumors, Karolinska University Hospital, SE-171 76 Stockholm, Sweden

⁴Regional Cancer Center of Southeast Sweden and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden

Corresponding Author

Received Date: February 21, 2022; Published Date: March 10, 2022

Abstract

Background

It is debated if all breast cancer (BC) patients with sentinel lymph node metastasis need axillary lymph node dissection (ALND). Based on clinical and biological factors, we explore a statistical model for predicting non sentinel node metastasis (non-SNm) in patients with positive SN (SN+).

Methods

We obtained data on patients from the Swedish National Quality Register for BC patients operated Jan 2008 - May 2012. Pearson´s chi-squared test was performed to compare clinical data with presence of non-SNm. The risk of non-SNm, estimated as odds ratio (OR), was calculated with multivariable logistic regression analysis and the results were visualized with a nomogram. Receiver operating characteristic (ROC) analysis was used to evaluate the discriminatory ability of the regression model (Prisk) in predicting non-SNm.

Results

Out of 5382 patients with SN+, 3181 had macro metastases at sentinel node biopsy and were treated with ALND. The non-SNm was statistically significant correlated to the proportion of SN+ (OR increased from 1.41 to 3.75 with raised proportion, p<0.001), tumor size (OR= 1.70, p<0.001), LVI-lymphovascular infiltration (OR= 1.63, p<0.001), HER2 expression (OR= 1.49, p=0.004) and multifocality (OR= 1.28, p=0.04). A cut-off value of 0.3 for Prisk based on the logistic regression model, yielded a sensitivity of 83.2% and specificity of 34.7 % in predicting non-SNm. The results were visualized with a nomogram where the proportion of SN+ was the most important factor.

Conclusion

In this study we present a statistical score encompassing BC biology with good sensitivity and acceptable specificity that may be used in predicting non-SNm as a complement to traditional staging system used in clinical assessment of BC.

Keywords: Breast cancer; Sentinel node; Axillary metastases; Nomogram/Scoring system

Article Details

Citation

Eva Vikhe Patil, Ivan Shabo, Oliver Gimm, Lars-Gunnar Arnesson, Helena Fohlin. Prediction of Non-Sentinel Node Metastasis in Breast Cancer - A Population-Based Study. Adv Can Res & Clinical Imag. 3(3): 2022. ACRCI.MS.ID.000565.