Article

An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement

Department of Gynecologic and Breast Cancers, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
Breast Cancer Research and Treatment (Impact Factor: 4.2). 05/2005; 91(2):113-9. DOI: 10.1007/s10549-004-5781-z
Source: PubMed

ABSTRACT Axillary lymph node dissection (ALND) is the current standard of care for breast cancer patients with sentinel lymph node (SN) involvement. However, the SN is the only involved axillary node in a significant proportion of these patients. Here we examined factors predictive of non-SN involvement in patients with a metastatic SN, in order to develop a scoring system for predicting non-SN involvement.
This study was based on a prospective database of 337 patients who underwent SN biopsy for breast cancer, of whom 81 (24%) were SN-positive; we examined factors predictive of non SN involvement in the 71 of these 81 women who underwent complementary ALND. All clinical and histological criteria were recorded and analysed according to non-SN status, by using Chi-2 analysis, Student's t-test, and multivariate logistic regression.
Univariate analysis showed a significant association between non-SN involvement and histological primary tumor size (p=0.0001), SN macrometastasis (p=0.01), the method used to detect SN metastasis (H&E versus immunohistochemistry) (p=0.03), the number of positive SNs (p=0.049), the proportion of involved SNs among all identified SNs (p=0.0001) and lymphovascular invasion (p=0.006). Histological primary tumor size (p=0.006), SN macrometastasis (p=0.02) and the proportion of involved SNs among all identified SNs (p=0.03) remained significantly associated with non-SN status in multivariate analysis. Based on the multivariate analysis, we developed an axilla scoring system (range 0-7) to predict the likelihood of non-SN metastasis in breast cancer patients with SN involvement.
In patients with invasive breast cancer and a positive SN, histological primary tumor size, the size of SN metastases, and the proportion of involved SNs among all identified SNs were independently predictive of non-SN involvement.

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    • "The limitation of use of nomograms mostly hinge on the fact that patient characteristics and treatment approach may vary in different populations. Three additional nomograms from France, Tenon Hospital, Paris [61], Cambridge, England [62] and Stamford, USA [64] have been developed more recently. The Tenon Hospital Study from France, uses three parameters including size of metastasis, percentage of positive sentinel nodes and pathologic tumour size. "
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    • "A possible criticism is that fewer SLNs are identified using blue dye alone. However, the median number of SLNs harvested per patient in our study was similar to that harvested in the study population from which the Tenon score was derived, where both blue dye and ISRN Oncology radiocolloid were used in combination [12]. Although we found the total number of SLNs harvested to be inversely correlated with the likelihood of non-SLN involvement, we failed to define an optimal number of SLNs that should be harvested. "
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    ABSTRACT: Background. Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods. Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results. Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs (P = 0.04), macrometastasis (P = 0.01), and inversely with the total number of SLNs harvested (P = 0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions. The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND.
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