FACTORS PREDICTING THE LIKELIHOOD OF NON-SENTINEL LYMPH NODE METASTASES IN BREAST CANCER PATIENTS WITH A POSITIVE SENTINEL LYMPH NODE: A SINGLE-CENTER STUDY

  • Borislav Kondov University Clinic for Thoracic and Vascular surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Sinisha Stojanovski Institute for Pathophysiology and Nuclear Medicine, Faculty of Medicine,Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Magdalena Bogdanova Institute for Pathology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Viktor Gruev Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, USA
  • Risto Cholancheski University Clinic for Thoracic and Vascular Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia
  • Ljubica Atanasova Faculty of Medicine , Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Goran Kondov University Clinic for Thoracic and Vascular surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R. North Macedonia

Abstract

This study aims to determine and appraise the factors predicting the likelihood of non-sentinel lymph node metastases in breast cancer patients, in order to avoid unnecessary axillary lymphadenectomy. A consecutive cohort study ascertained 133 patients with a detected sentinel lymph node, who met the inclusion criteria: early breast cancer (in T1, 2; N0 and M0 stage), tumor size of 5 cm or less and clinically negative axillary status. The patients were then divided into three groups, according to the SLN and NSLN status (group 1 = SLN -; group 2 = SLN +, NSLN -; group 3 = SLN +; NSLN +). Number of patients was n=98; n=19 and n=16, respectively. Aim of the study is to determine factors that can predict positivity of non-sentinel lymph nodes in condition when sentinel lymph nodes were positive. According to the correlation matrix, Kolmogorov-Smirnov test, when comparing the negative and positive NSLNs in the group of positive SLNs, whether NSLN will be positive or not, depends on the tumor size, number of detected NSLNs and pT. It also depends on the age, number of positive and negative SLNs, number of negative NSLNs, pN, G, stage, positivity of p53 and positivity of Her 2 new. Longer follow-up studies of a larger group of patients are required to define the exact factors contributing to a positive NSLN when SLN is positive. In our study the determined risk factors which contribute to the positivity of NSLNs were: age, number of identified and negative NSLNs, number of negative and positive SLNs, pN, G, stage of the disease,  positivity of p53 and positivity of Her 2 new.


Keywords: lymphadenectomy, sentinel lymph node, non-sentinel lymph node, breast cancer, metastases, risk factors for positivity of SLND or NSLD.  


 https://doi.org/10.55302/JMS2251085k

References

1. Cordero JM, Bernet L, Cano R, Bustamante M, Vila R, Ballester B, González PJ.Study of the sentinel node in breast cancer using lymphoscintigraphy and a fast method for cytokeratin.Rev Esp Med Nucl. 2004 Jan-Feb;23(1):9-14. (42).
2. Cserni G, Bori R, Maráz R, Leidenius MH, Meretoja TJ, Heikkila PS, Regitnig P, Luschin-Ebengreuth G, Zgajnar J, Perhavec A, Gazic B, Lázár G, Takács T, Vörös A, Audisio RA.Multi-institutional comparison of non-sentinel lymph node predictive tools in breast cancer patients with high predicted risk of further axillary metastasis.Pathol Oncol Res. 2013 Jan;19(1):95-101.(46).
3. Cserni G., Boross G., Maráz R., Leidenius M.H.K., Meretoja T.J., Heikkila P.S., Regitnig P.,Luschin-EbengreuthG., Zgajnar J., PerhavecA., Gazic B., Lázár G., Takács T., Vörös A., Audisio R.A.Multicentre validation of different predictive tools of non-sentinel lymph nodeinvolvement in breast cancer. Surgical Oncology 21 (2012) 59-65 (47).
4. Dingemans SA, de Rooij P, van der Vuurst de Vries R, Budel L, Contant C, van der Pool A- Validation of Six Nomograms for Predicting Non-sentinel Lymph Node Metastases in a Dutch Breast Cancer Population.- Ann Surg Oncol (2016) 23:477–481 DOI 10.1245/s10434-015-4858-8.
5. Durak MG, Akansu B, Akin MM, Sevınç AI, Koçdor MA, Saydam S, Harmancioğlu O,
Ellıdokuz H, Bekış R, Canda T. Factors predicting non-sentinel lymph nodeinvolvement in sentinel node positive breast carcinoma. Turk Patoloji Derg.2011;27(3):189-95. doi: 10.5146/tjpath.2011.01074. PMID: 21935867.
6. Freedman GM, Fowble BL, Li T, Hwang ES, Schechter N, Devarajan K, Anderson PR, Sigurdson ER, Goldstein LJ, Bleicher RJ.Risk of positive nonsentinel nodes in women with 1-2 positive sentinel nodes related to age and molecular subtype approximated by receptor status.Breast J. 2014 Jul-Aug;20(4):358-63. (72).
7. Gill G on behalf of the snac Trial Group of the Royal Austral- asian College of Surgeons and nhmrc Clinical Trials Centre. Sentinel-lymph-node-based management or routine axillary clearance? One-year outcomes of Sentinel Node Biopsy Versus Axillary Clearance (snac): a randomized controlled surgical trial. Ann Surg Oncol 2009;16:266–75.
8. Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the acosog Z0011 (Alliance) randomized clinical trial. JAMA 2017;318:918–26.
9. Gülben K., Berberoğlu U., Aydoğan O., and Kınaş V.-Subtype Is a Predictive Factor of Nonsentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer PatientsJ Breast Cancer. 2014 Dec; 17(4): 370–375.Published online 2014 Dec 26.(93).
10. Gur AS, Unal B, Johnson R, Ahrendt G, Bonaventura M, Gordon P, Soran A.Predictive probability of four different breast cancer nomograms for nonsentinel axillary lymph node metastasis in positive sentinel node biopsy.J Am Coll Surg. 2009 Feb;208(2):229-35.(94).
11. Gur AS, Unal B, Ozbek U, Ozmen V, Aydogan F, Gokgoz S, Gulluoglu BM, Aksaz E, Ozbas S, Baskan S, Koyuncu A, Soran A; Turkish Federation of Breast Disease Associations Protocol MF08-01 investigators.- Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study.Eur J Surg Oncol. 2010 Jan;36(1):30-5.(95).
12. Hwang RF, Krishnamurthy S, Hunt KK, Mirza N, Ames FC, Feig B, et al. Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer. Ann Surg Oncol. 2003;10(3):248–54(107).
13. Kondov B.-Impact of size of the tumour, persistence of estrogen receptors, progesterone receptors, HER2 neu receptors and Ki67 values on positivity of sentinel lymph node, in patients with early breast cancer- PhD thesis, Skopje 2018.
14. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the nsabp B-32 ran- domised phase 3 trial. Lancet Oncol 2010;11:927–33.
15. Kuo YL, Chen WC, Yao WJ, Cheng L, Hsu HP, Lai HW, Kuo SJ, Chen DR, Chang TW.Validation of Memorial Sloan-Kettering Cancer Center nomogram for prediction of non-sentinel lymph node metastasis in sentinel lymph node positive breast cancer patients an international comparison.Int J Surg. 2013;11(7):538-43. (144).
16. Majid S , Rydén L and ManjerJ.-Determinants for non-sentinel node metastases in primary invasive breast cancer: a population-based cohort study of 602 consecutive patients with sentinel node metastases-BMC Cancer (2019) 19:626 https://doi.org/10.1186/s12885-019-5823-x.
17. Menard S. C-erb-B2/neu and response to CMF and hormonal manipulation. fur J Cancer. 2000;36(suppI 5):S48. Abstract 19. 2000. (167).
18. Nadeem RM, Gudur LD, Saidan ZA.-An independent assessment of the 7 nomograms for predicting the probability of additional axillary nodal metastases after positive sentinel lymph node biopsy in a cohort of British patients with breast cancer.Clin Breast Cancer. 2014 Aug;14(4):272-9. (174).
19. Nikolic S., Opric M.- Proliferativne bolesti dojke, Komerc print, Beograd 1990.(178).
20. van den Hoven I, Kuijt G, Roumen R, Voogd A, Steyerberg EW, Vergouwe Y.A head to head comparison of nine tools predicting non-sentinel lymph node status in sentinel node positive breast cancer women.J Surg Oncol. 2015 Aug;112(2):133-8. (247).
21. van den Hoven I, van Klaveren D, Voogd AC, Vergouwe Y, Tjan-Heijnen V, Roumen RM.A Dutch Prediction Tool to Assess the Risk of Additional Axillary Non-Sentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer Patients.Clin Breast Cancer. 2016 Apr;16(2):123-30. (248).
22. Van Zee KJ, Manasseh DM, Bevilacqua JL. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol.2003;10(10):1140–51. (253).
Published
2022-05-04
How to Cite
KONDOV, Borislav et al. FACTORS PREDICTING THE LIKELIHOOD OF NON-SENTINEL LYMPH NODE METASTASES IN BREAST CANCER PATIENTS WITH A POSITIVE SENTINEL LYMPH NODE: A SINGLE-CENTER STUDY. Journal of Morphological Sciences, [S.l.], v. 5, n. 1, p. 85-92, may 2022. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol5no1-11>. Date accessed: 03 dec. 2022.
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