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Rosen J, Manley LR, Patel A, Gandamihardja T, Rao A. Prediction of negative axillary node clearance by sentinel node-positive to total node ratio: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:4689-4693. [PMID: 37811068 PMCID: PMC10553108 DOI: 10.1097/ms9.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/20/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Increasing evidence suggests that de-escalation of axillary surgery is safe, without significantly impacting patient outcome. Obtaining positive lymph nodes at a sentinel lymph node biopsy (SNB) can guide decisions toward the requirement of axillary nodal clearance (ANC). However, methods to predict how many further nodes will be positive are not available. This study investigates the feasibility of predicting the likelihood of a negative ANC based on the ratio between positive nodes and the total number of lymph nodes excised at SNB. Methods Retrospective data from January 2017 to March 2022 was collected from electronic medical records. Patients with oestrogen receptor (ER) positive and HER2 negative receptor disease were included in the study. ER-negative and HER2-positive disease was excluded, alongside patients who had chemotherapy before ANC. Results Of 102 patients, 58.8% (n=60) had no macrometastasis at ANC. On average, 2.76 lymph nodes were removed at SNB. A higher SNB ratio of positive to total nodes [OR 11.09 (CI 95% 2.33-52.72), P=0.002] had a significant association with positive nodes during ANC. SNB ratio less than or equal to 0.33 (1/3) had a specificity of 79.2% in identifying cases that later had a negative completion ANC, with a 95.8% specificity of no further upgrade of nodal staging. Conclusion A low SNB ratio of less than 0.33 (1/3) has a high specificity in excluding the upgradation of nodal staging on completion of ANC, with a false-negative rate of less than 5%. This may be used to identify patients with a low risk of axillary metastasis, who can avoid ANC.
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Affiliation(s)
- Jemima Rosen
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Broomfield, Chelmsford, UK
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Kuo CY, Wei PL, Chen CC, Lin YK, Kuo LJ. Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery. World J Gastrointest Surg 2022; 14:765-777. [PMID: 36157368 PMCID: PMC9453330 DOI: 10.4240/wjgs.v14.i8.765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma (PS), which can cause drastic changes in lifestyle and physical perceptions.
AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.
METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.
RESULTS The PS rate after sphincter-saving surgery was 15.1% (59/391) in our study after a median follow-up of 47.3 mo (range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903 (95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.
CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.
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Affiliation(s)
- Chih-Yu Kuo
- Department of Surgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Po-Li Wei
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chia-Che Chen
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 33301, Taiwan
| | - Li-Jen Kuo
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei 11031, Taiwan
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Herrero M, Ciérvide R, Calle-Purón ME, Valero J, Buelga P, Rodriguez-Bertos I, Benassi L, Montero A. Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making. World J Clin Oncol 2021; 12:675-687. [PMID: 34513601 PMCID: PMC8394159 DOI: 10.5306/wjco.v12.i8.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Axillary sentinel lymph node biopsy (SLNB) is standard treatment for patients with clinically and pathological negative lymph nodes. However, the role of completion axillary lymph node dissection (cALND) following positive sentinel lymph node biopsy (SLNB) is debated.
AIM To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of long-term complications and create a Preoperative Clinical Risk Index (PCRI) that helps us in our clinical practice to optimize the selection of these patients.
METHODS Patients with positive SLNB who underwent a cALND were included in this study. Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND.
RESULTS From May 2007 to April 2014, we performed 1140 SLN biopsies, of which 125 were positive for tumor and justified to practice a posterior cALND. Pathologic findings at SLNB were micrometastases (mic) in 29 cases (23.4%) and macrometastasis (MAC) in 95 cases (76.6%). On univariate analysis of the 95 patients with MAC, statistically significant factors included: age, grade, phenotype, histology, lymphovascular invasion, lymph-node tumor size, and number of positive SLN. On multivariate analysis, only lymph-node tumor size (≤ 20 mm) and number of positive SLN (> 1) retained significance. A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND. Patients with a PCRI ≤ 15 has low probability (< 10%) of having additional lymph node involvement, a PRCI between 15-17.6 has a probability of 43%, and the probability increases to 69% in patients with a PCRI > 17.6.
CONCLUSION The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND. Further prospective studies are necessary to validate PCRI clinical generalization.
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Affiliation(s)
- Mercedes Herrero
- Department of Gynecology and Obstetrics, HM Hospitales, Madrid 28050, Spain
| | - Raquel Ciérvide
- Department of Radiation Oncology, HM Hospitales, Madrid 28050, Spain
| | - Maria Elisa Calle-Purón
- Department of Preventive Medicine and Public Health, Complutense University of Madrid, Madrid 28050, Spain
| | - Javier Valero
- Department of Gynecology and Obstetrics, HM Hospitales, Madrid 28050, Spain
| | - Paula Buelga
- Department of Gynecology and Obstetrics, HM Hospitales, Madrid 28050, Spain
| | | | - Leticia Benassi
- Department of Gynecology and Obstetrics, HM Hospitales, Madrid 28050, Spain
| | - Angel Montero
- Department of Radiation Oncology, HM Hospitales, Madrid 28050, Spain
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Jung JJ, Kang E, Kim EK, Kim SM, Jang M, La Yun B, Park SY, Shin HC. External validation and modification of nomogram for predicting positive resection margins before breast conserving surgery. Breast Cancer Res Treat 2020; 183:373-380. [PMID: 32647937 DOI: 10.1007/s10549-020-05779-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/29/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE A positive resection margin after breast conserving surgery (BCS) is the most important risk factor for tumor recurrence. In 2012, Seoul National University Hospital (SNUH) breast surgery team developed a nomogram for predicting positive resection margins before BCS to provide individual surgical plans that could reduce local recurrence without increasing re-excision rates. The purpose of this study was to validate this nomogram using an external cohort and to test if addition of surgeon-related factor could improve its use as a predictive model. METHODS A total of 419 patients with breast cancer who underwent BCS from January to December 2018 were retrospectively reviewed. Using the SNUH BCS nomogram, risk score for positive resection margins was calculated for 343 patients. The predictive accuracy of the nomogram was assessed, and multivariable logistic regression analyses were performed to evaluate the nomogram's predictive variables. RESULTS The positive resection margin rate of the current external validation cohort was 13.5% (46 out of 343), compared to 14.6% (151 out of 1034) of the original study. The discrimination power of the SNUH BCS nomogram as measure by area under the receiver operating characteristics curve (AUC) was 0.656 [95% confidence interval (CI) 0.576-0.735]. This result is lower than expected value of 0.823 [95% CI 0.785-0.862], the AUC of the original study. Multivariable logistic regression analysis showed that, among the five nomogram variables, presence of tumor size discrepancy greater than 0.5 cm between MRI and ultrasonography (OR 2.445, p = 0.019) and presence of ductal carcinoma in situ on needle biopsy (OR 2.066, p = 0.048) were significantly associated with positive resection margins. Finally, the nomogram score was re-calculated by adding each surgeon's resection margin positive rate as odds ratio and the AUC was increased to 0.733. CONCLUSIONS Validation of the SNUH BCS nomogram was not successful in the current study as much as its original publication. However, we could improve its predictive power by including surgeon-related factor. Before applying a published nomogram as a preoperative predictive model, we suggest each institution to validate the model and adjust it with surgeon-related factor. Addition of new factors to currently available nomograms holds promise for improving its applicability for breast cancer patients at the actual clinical level.
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Affiliation(s)
- Ji-Jung Jung
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. .,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Zhang W, Xu J, Wang K, Tang XJ, Liang H, He JJ. Independent risk factors for axillary lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes. BMC WOMENS HEALTH 2020; 20:143. [PMID: 32646416 PMCID: PMC7350751 DOI: 10.1186/s12905-020-01004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/26/2020] [Indexed: 12/24/2022]
Abstract
Background The benefit of axillary lymph node dissection (ALND) in breast cancer patients with one or two positive sentinel lymph nodes (SLNs) remains inconclusive. The purpose of this study was to identify risk factors independently associated with axillary lymph node (ALN) metastasis. Methods We retrospectively analyzed data from 389 Chinese breast cancer patients with one or two positive SLNs who underwent ALND. Univariate and multivariate logistic regression analyses were performed to identify ALN metastasis-associated risk factors. Results Among the 389 patients, 174 (44.7%) had ALN metastasis, while 215 (55.3%) showed no evidence of ALN metastasis. Univariate analysis revealed significant differences in age (< 60 or ≥ 60 years), human epidermal growth factor receptor-2 (Her-2) status, and the ratio of positive to total SLNs between the ALN metastasis and non-metastasis groups (P < 0.05). The multivariate analysis indicated that age, the ratio of positive to total SLNs, and occupations were significantly different between the two groups. Lastly, younger age (< 60 years), a higher ratio of positive to total SLNs, and manual labor jobs were independently associated with ALN metastasis (P < 0.05). Conclusions The risk of ALN metastasis in breast cancer patients with one or two positive SLNs can be further increased by younger age, manual labor jobs, and a high ratio of positive to total SLNs. Our findings may also aid in identifying which patients with one or two positive SLNs may not require ALND.
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Affiliation(s)
- Wei Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Jing Xu
- Department of Geriatric Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Xiao-Jiang Tang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Hua Liang
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China.
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Sun X, Zhang Y, Wu S, Fu L, Yun JP, Wang YS. Intraoperative Prediction Of Non-Sentinel Lymph Node Metastasis Based On The Molecular Assay In Breast Cancer Patients. Cancer Manag Res 2019; 11:9715-9723. [PMID: 31814766 PMCID: PMC6863878 DOI: 10.2147/cmar.s226733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/04/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose The aim of the study is to construct an intraoperative nomogram for the prediction of non-sentinel lymph node (NSLN) metastasis based on the one-step nucleic acid amplification assay in breast cancer patients. Methods A total of 552 patients were enrolled in the training study and 1090 patients were enrolled in the validation study. The nomogram was constructed based on the molecular assay with logistic multivariate regression analysis in the training study and was validated in the validation study. Results A novel nomogram model was constructed with the total tumor load, the clinical primary tumor size, the number of positive and negative sentinel lymph nodes. The area under the receiver operating characteristic curve (AUC) of the model was 0.842. The AUC of the model which was sensitive to discern the patients with the stage of pN1 and ≥pN2 was 0.861. Conclusion The nomogram model will help to guide the axillary management intraoperatively and precisely confirm the target region of radiotherapy postoperatively.
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Affiliation(s)
- Xiao Sun
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
| | - Yan Zhang
- Department of Breast and Thyroid Surgery, Zibo Central Hospital, Zibo, People's Republic of China
| | - Shuang Wu
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
| | - Li Fu
- Department of Pathology, Cancer Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Jing-Ping Yun
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yong-Sheng Wang
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, People's Republic of China
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Barron AU, Hoskin TL, Boughey JC. Predicting Non-sentinel Lymph Node Metastases in Patients with a Positive Sentinel Lymph Node After Neoadjuvant Chemotherapy. Ann Surg Oncol 2018; 25:2867-2874. [DOI: 10.1245/s10434-018-6578-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 11/18/2022]
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Zhang J, Li X, Huang R, Feng WL, Kong YN, Xu F, Zhao L, Song QK, Li J, Zhang BN, Fan JH, Qiao YL, Xie XM, Zheng S, He JJ, Wang K. A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study. Oncotarget 2017; 8:35311-35325. [PMID: 27852049 PMCID: PMC5471057 DOI: 10.18632/oncotarget.13330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/26/2016] [Indexed: 01/17/2023] Open
Abstract
Axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) alone may lead to postoperative complications. Among patients with positive ALN in the preoperative examination, approximately 40% patients do not have SLN metastasis. Herein, we aimed to develop a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. We retrospectively analyzed the clinicopathological features of 4211 female patients with breast cancer who were diagnosed in seven breast cancer centers representing entire China, over 10 years (1999-2008). The patients were randomly categorized into a training cohort or validation cohort (3:1 ratio). Multivariate logistic regression analysis was performed for 1869 patients with complete information on the study variables. Age at diagnosis, tumor size, tumor quadrant, clinical nodal status, local invasion status, pathological type, and molecular subtypes were the independent predictors of ALN metastasis. The nomogram was then developed using the seven variables. Further, it was subsequently validated in 642 patients with complete data on variables in the validation cohort. Coefficient of determination (R²) and the area under the receiver-operating characteristic (ROC) curve (AUC) were calculated to be 0.979 and 0.7007, showing good calibration and discrimination of the model, respectively. The false-negative rates of the nomogram were 0 and 6.9% for the predicted risk cut-off values of 14.03% and 20%, respectively. Therefore, when the predicted risk is less than 20%, SLNB may be avoided. After further validation in various patient populations, this model may support increasingly limited axillary surgery in breast cancer.
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Affiliation(s)
- Jian Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Xiao Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Rong Huang
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Wei-Liang Feng
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R. China
| | - Ya-Nan Kong
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Feng Xu
- Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, P.R. China
| | - Qing-Kun Song
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jing Li
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Bao-Ning Zhang
- Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Shan Zheng
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
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Multivariate Preoperative and Intraoperative Predictors of Postmastectomy Radiation Therapy in Patients for Whom Immediate Breast Reconstruction Is Planned. Plast Reconstr Surg 2017; 139:599e-605e. [DOI: 10.1097/prs.0000000000003052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Cancer staging and grading are used to predict the clinical behavior of malignancies, establish appropriate therapies, and facilitate exchange of precise information between clinicians. The internationally accepted criterion for cancer staging, the tumor-node-metastasis (TNM) system, includes: (1) tumor size and local growth (T), (2) extent of lymph node metastases (N), and (3) occurrence of distant metastases (M). Clinical stage is established before initiation of therapy and is determined by physical examination, laboratory findings, and imaging studies. Pathologic stage is determined following surgical exploration of disease and histologic examination of tissue. The TNM classification system has evolved over 70 years to accommodate increasing knowledge about cancer biology. Molecular technologies such as genomic and proteomic profiling of tumors could eventually be incorporated into the TNM staging system. This chapter describes the current TNM system using breast, lung, ovarian, and prostate cancer examples.
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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; 16:123-30. [DOI: 10.1016/j.clbc.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/22/2015] [Accepted: 09/11/2015] [Indexed: 01/17/2023]
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[Axillary management in breast cancer: The French practice versus recommendations in the post-2011 era]. ACTA ACUST UNITED AC 2016; 45:451-8. [PMID: 26989008 DOI: 10.1016/j.jgyn.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/18/2016] [Accepted: 01/28/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Today, according to St-Gallen and ASCO clinical guidelines, axillary lymph node dissection (ALND) should be avoided in patients who meet the ACOSOG Z011 criteria. In French guidelines, ALND is still recommended in case of macrometastasis in sentinel lymph node (SLN) and in case of micrometastasis without systemic treatment. We performed a survey of the French practices in the management of the axilla. MATERIAL AND METHODS A questionnaire was sent to 454 breast surgeons between June 2014 and January 2015. Questionnaire included items about: indications of SLN biopsy, frequency of ALND in case of metastatic SLN and modality of radiotherapy in case of metastatic SLN without ALND. RESULTS A total of 169 surgeons (37%) answer the questionnaire. Twenty-one percent of surgeons avoid ALND in case of macrometastasis. Thirty-two percent do not perform extemporaneous examination of SLN. Only 8.4% of practionners performed a SLN biopsy after neoadjuvant chemotherapy. Fourteen percent performed a SLN biopsy in case of multicentric tumors, while it is not recommended. In case of positive SLN without ALND completion, radiotherapy does not change in 34% while irradiation fields are expanded in 44%. CONCLUSIONS Significant unconformities are observed towards national recommendations. The divergence between French and international guidelines leads to heterogeneous surgical practices.
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Factors Influencing Non-sentinel Node Involvement in Sentinel Node Positive Patients and Validation of MSKCC Nomogram in Indian Breast Cancer Population. Indian J Surg Oncol 2015; 6:337-45. [PMID: 27065658 DOI: 10.1007/s13193-015-0431-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/15/2015] [Indexed: 12/23/2022] Open
Abstract
Current guidelines recommend completion axillary lymphnode dissection (ALND) when sentinel lymphnode (SLN) contains metastatic tumor deposit. In consequent ALND sentinel node is the only node involved by tumor in 40-70 % of cases. Recent studies demonstrate the oncologic safety of omitting completion ALND in low risk patients. Several nomograms (MSKCC, Stanford, MD Anderson score, Tenon score) had been developed in predicting the likelihood of additional nodes metastatic involvement. We evaluated accuracy of MSKCC nomogram and other clinicopathologic variables associated with additional lymph node metastasis in our patients. A total of 334 patients with primary breast cancer patients underwent SLN biopsy during the period Jan 2007 to June 2014. Clinicopathologic variables were prospectively collected. Completion ALND was done in 64 patients who had tumor deposit in SLN. The discriminatory accuracy of nomogram was analyzed using Area under Receiver operating characteristic curve (ROC). SLN was the only node involved with tumor in 69 % (44/64) of our patients. Additional lymph node metastasis was seen in 31 % (20/64). On univariate analysis, extracapsular infiltration in sentinel node and multiple sentinel nodes positivity were significantly associated (p < 0.05) with additional lymph node metastasis in the axilla. Area under ROC curve for nomogram was 0.58 suggesting poor performance of the nomogram in predicting NSLN involvement. Sentinel nodes are the only nodes to be involved by tumor in 70 % of the patients. Our findings indicate that multiple sentinel node positivity and extra-capsular invasion in sentinel node significantly predicted the likelihood of additional nodal metastasis. MSKCC nomogram did not reliably predict the involvement of additional nodal metastasis in our study population.
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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; 112:133-8. [PMID: 26258749 DOI: 10.1002/jso.23992] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES This study was conducted to evaluate the performance of available tools predicting non-sentinel lymph node (non-SLN) status in women with SLN positive breast cancer and to see if they can be safely used in everyday clinical practice. METHODS Data of 220 women with breast cancer who underwent a SLN biopsy at the Máxima Medical Centre between 2000-2008 were analysed. Tools evaluated were: the models from Memorial Sloan Kettering Cancer Centre, Stanford, Mayo, Cambridge, Gur, and MOU, and the scores from Saidi, Tenon, and MDA. Model performance was assessed using calibration, discrimination and Nagelkerke's explained variation. RESULTS The MSKCC nomogram showed best overall performance with best discrimination (AUC 0.69), second best calibration, and highest explained variation (31%). The 10% low risk threshold led to defining only 22% (38/176) of the women as being low risk while in fact 66% (116/176) were non-SLN negative. The false negative rate was 13% (5/38). CONCLUSIONS Current models for predicting non-SLN metastases in SLN positive breast cancer are not yet ready for implementation in general practice. Further research efforts should improve model performance in selecting patients or perhaps find a role in support in the paradigm shift to a "treat none unless" approach.
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Affiliation(s)
| | - Gert Kuijt
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Rudi Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Maastricht University Medical Center, GROW-school for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Adri Voogd
- Maastricht University Medical Center, GROW-school for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Yvonne Vergouwe
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Bi X, Wang Y, Li M, Chen P, Zhou Z, Liu Y, Zhao T, Zhang Z, Wang C, Sun X, Qiu P. Validation of the Memorial Sloan Kettering Cancer Center nomogram for predicting non-sentinel lymph node metastasis in sentinel lymph node-positive breast-cancer patients. Onco Targets Ther 2015; 8:487-93. [PMID: 25750542 PMCID: PMC4348057 DOI: 10.2147/ott.s78903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The main purpose of the study reported here was to validate the clinical value of the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram that predicts non-sentinel lymph node (SLN) metastasis in SLN-positive patients with breast cancer. METHODS Data on 1,576 patients who received sentinel lymph node biopsy (SLNB) at the Shandong Cancer Hospital from December 2001 to March 2014 were collected in this study, and data on 509 patients with positive SLN were analyzed to evaluate the risk factors for non-SLN metastasis. The MSKCC nomogram was used to estimate the probability of non-SLN metastasis and was compared with actual probability after grouping into deciles. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve. RESULTS Tumor size, histological grade, lymphovascular invasion, multifocality, number of positive SLNs, and number of negative SLNs were correlated with non-SLN metastasis (P<0.05) by univariate analysis. However, multivariate analysis showed that tumor size (P=0.039), histological grade (P=0.043), lymphovascular invasion (P=0.001), number of positive SLNs (P=0.001), and number of negative SLNs (P=0.000) were identified as independent predictors for non-SLN metastasis. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.722. Patients with predictive values lower than 10% (97/492, 19.7%) had a frequency of non-SLN metastasis of 17.5% (17/97). CONCLUSION The MSKCC nomogram can provide an accurate prediction of the probability of non-SLN metastasis, and offers a reference basis about axillary lymph node dissection. Axillary lymph node dissection could be avoided in patients with predictive values lower than 10%.
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Affiliation(s)
- Xiang Bi
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Yongsheng Wang
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Minmin Li
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Peng Chen
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Zhengbo Zhou
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Yanbing Liu
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Tong Zhao
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Zhaopeng Zhang
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Chunjian Wang
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Xiao Sun
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
| | - Pengfei Qiu
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China
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Agostinho JL, Zhao X, Sun W, Laronga C, Kiluk JV, Chen DT, Lee MC. Prediction of positive margins following breast conserving surgery. Breast 2015; 24:46-50. [DOI: 10.1016/j.breast.2014.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022] Open
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Mittendorf EA, Ballman KV, McCall LM, Yi M, Sahin AA, Bedrosian I, Hansen N, Gabram S, Hurd T, Giuliano AE, Hunt KK. Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer. J Clin Oncol 2014; 33:1119-27. [PMID: 25488970 DOI: 10.1200/jco.2014.57.2958] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer differentiates patients with T1 tumors and lymph node micrometastases (stage IB) from patients with T1 tumors and negative nodes (stage IA). This study was undertaken to determine the utility of the stage IB designation. PATIENTS AND METHODS The following two cohorts of patients with breast cancer were identified: 3,474 patients treated at The University of Texas MD Anderson Cancer Center from 1993 to 2007 and 4,590 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0010 trial. Clinicopathologic and outcomes data were recorded, and disease was staged according to the seventh edition AJCC staging system. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were determined using the Kaplan-Meier method and compared using the log-rank test. RESULTS Median follow-up times were 6.1 years and 9.0 years for the MD Anderson Cancer Center and ACOSOG cohorts, respectively. In both cohorts, there were no significant differences between patients with stage IA and stage IB disease in 5- or 10-year RFS, DSS, or OS. Estrogen receptor (ER) status and grade significantly stratified patients with stage I disease with respect to RFS, DSS, and OS. CONCLUSION Among patients with T1 breast cancer, individuals with micrometastases and those with negative nodes have similar survival outcomes. ER status and grade are better discriminants of survival than the presence of small-volume nodal metastases. In preparing the next edition of the AJCC staging system, consideration should be given to eliminating the stage IB designation and incorporating biologic factors.
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Affiliation(s)
- Elizabeth A Mittendorf
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Karla V Ballman
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Linda M McCall
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Min Yi
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aysegul A Sahin
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Isabelle Bedrosian
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nora Hansen
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sheryl Gabram
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Thelma Hurd
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Armando E Giuliano
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kelly K Hunt
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
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Ho AS, Wang L, Palmer FL, Yu C, Toset A, Patel S, Kattan MW, Tuttle RM, Ganly I. Postoperative Nomogram for Predicting Cancer-Specific Mortality in Medullary Thyroid Cancer. Ann Surg Oncol 2014; 22:2700-6. [PMID: 25366585 DOI: 10.1245/s10434-014-4208-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is a rare thyroid cancer accounting for 5 % of all thyroid malignancies. The purpose of our study was to design a predictive nomogram for cancer-specific mortality (CSM) utilizing clinical, pathological, and biochemical variables in patients with MTC. METHODS MTC patients managed entirely at Memorial Sloan-Kettering Cancer Center between 1986 and 2010 were identified. Patient, tumor, and treatment characteristics were recorded, and variables predictive of CSM were identified by univariable analyses. A multivariable competing risk model was then built to predict the 10-year cancer specific mortality of MTC. All predictors of interest were added in the starting full model before selection, including age, gender, pre- and postoperative serum calcitonin, pre- and postoperative CEA, RET mutation status, perivascular invasion, margin status, pathologic T status, pathologic N status, and M status. Stepdown method was used in model selection to choose predictive variables. RESULTS Of 249 MTC patients, 22.5 % (56/249) died from MTC, whereas 6.4 % (16/249) died secondary to other causes. Mean follow-up period was 87 ± 67 months. The seven variables with the highest predictive accuracy for cancer specific mortality included age, gender, postoperative calcitonin, perivascular invasion, pathologic T status, pathologic N status, and M status. These variables were used to create the final nomogram. Discrimination from the final nomogram was measured at 0.77 with appropriate calibration. CONCLUSIONS We describe the first nomogram that estimates cause-specific mortality in individual patients with MTC. This predictive nomogram will facilitate patient counseling in terms of prognosis and subsequent clinical follow up.
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Affiliation(s)
- Allen S Ho
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Liu M, Wang S, Pan L, Yang D, Xie F, Liu P, Guo J, Zhang J, Zhou B. A new model for predicting non-sentinel lymph node status in Chinese sentinel lymph node positive breast cancer patients. PLoS One 2014; 9:e104117. [PMID: 25111296 PMCID: PMC4128817 DOI: 10.1371/journal.pone.0104117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/04/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Our goal is to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stanford Online Calculator (SOC) for predicting non-sentinel lymph node (NSLN) metastasis in Chinese patients, and develop a new model for better prediction of NSLN metastasis. METHODS The MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients. Univariate and multivariate analyses were performed to evaluate the relationship between NSLN metastasis and clinicopathologic factors, using the medical records of the first 80 breast cancer patients. A new model predicting NSLN metastasis was developed from the 80 patients. RESULTS The MSKCC and SOC predicted NSLN metastasis in a series of 120 patients with an area under the receiver operating characteristic curve (AUC) of 0.688 and 0.734, respectively. For predicted probability cut-off points of 10%, the false-negative (FN) rates of MSKCC and SOC were both 4.4%, and the negative predictive value (NPV) 75.0% and 90.0%, respectively. Tumor size, Kiss-1 expression in positive SLN and size of SLN metastasis were independently associated with NSLN metastasis (p<0.05). A new model (Peking University People's Hospital, PKUPH) was developed using these three variables. The MSKCC, SOC and PKUPH predicted NSLN metastasis in the second 40 patients from the 120 patients with an AUC of 0.624, 0.679 and 0.795, respectively. CONCLUSION MSKCC nomogram and SOC did not perform as well as their original researches in Chinese patients. As a new predictor, Kiss-1 expression in positive SLN correlated independently with NSLN metastasis strongly. PKUPH model achieved higher accuracy than MSKCC and SOC in predicting NSLN metastasis in Chinese patients.
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Affiliation(s)
- Miao Liu
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Shu Wang
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Lu Pan
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Deqi Yang
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Fei Xie
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Peng Liu
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Jiajia Guo
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Jiaqing Zhang
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Bo Zhou
- Breast Disease Center, Peking University People's Hospital, Beijing, China
- * E-mail:
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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; 14:272-9. [PMID: 25037530 DOI: 10.1016/j.clbc.2014.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Axillary lymph node dissection (ALND) is currently the recommended procedure in patients with tumor-positive sentinel lymph node biopsy (SLNB). A significant proportion of patients with positive SLNs will not have any additional metastases in nonsentinel lymph nodes (NSLNs). Predictive nomograms could identify a subgroup of patients with low or high risk of further disease in whom completion ALND can be avoided or recommended. The aim of this study was to assess the accuracy of the currently available 7 nomograms in a cohort of British patients with breast cancer. PATIENTS AND METHODS A total of 138 patients with positive SLNs who underwent completion ALND were identified. Data were then used to calculate the probability of further metastases in NSLNs predicted by the 7 nomograms that are currently in use: the MSKCC (Memorial Sloan Kettering Cancer Center), Cambridge, Turkish, Stanford, MDACC (University of Texas MD Anderson Cancer Center), Tenon, and MOU (Masarykuv onkologický ústav, Masaryk Memorial Cancer Institute) models. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated for each nomogram. RESULTS Of the 138 patients, 54 (41%) had additional metastases in NSLNs. AUC values for the MSKCC, Cambridge, Turkish, Stanford, MDACC, Tenon, and MOU models are 0.68, 0.68, 0.70, 0.69, 0.56, 0.63, and 0.74, respectively. CONCLUSION The MOU nomogram was more predictive than the other nomograms, with a better AUC value and false-negative rate. None of the models were able to achieve AUC value ≥ 0.80 in a cohort of British patients with breast cancer.
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Omair M, Al-Azawi D, Mann GB. Sentinel node biopsy in breast cancer revisited. Surgeon 2014; 12:158-65. [PMID: 24548701 DOI: 10.1016/j.surge.2013.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/23/2013] [Accepted: 12/23/2013] [Indexed: 01/17/2023]
Abstract
The axilla has long been a focus of clinicians' attention in the management of breast cancer. The approach to the axilla has undergone dramatic changes over the last century, from radical and extended radical excisions, through the introduction of sentinel node biopsy for node negative patients to the current situation where selective management of those with nodal involvement is being introduced. The introduction of lymphatic mapping and sentinel node biopsy in the 1990's has been key to the major changes that have occurred. In less than 20 years it has moved from a hypothesis to a situation where it is the default approach to almost all clinically node negative patients and is being considered in other situations where axillary clearance was previously considered standard. This article reviews the development and introduction of sentinel node biopsy, its current uncertainties and limitations, and possible future developments.
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Affiliation(s)
- Mohammad Omair
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Dhafir Al-Azawi
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia; St James's Hospital, Trinity College, Dublin, Ireland
| | - Gregory Bruce Mann
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Australia; The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia.
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Koca B, Kuru B, Ozen N, Yoruker S, Bek Y. A Breast Cancer Nomogram for Prediction of Non-Sentinel Node Metastasis - Validation of Fourteen Existing Models. Asian Pac J Cancer Prev 2014; 15:1481-8. [DOI: 10.7314/apjcp.2014.15.3.1481] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Use of Established Nomograms to Predict Non-Sentinel Lymph Node Metastasis. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-013-0137-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Sentinel node biopsy has become well accepted as a minimally invasive means of accurately staging the axilla in breast cancer patients. Patients with metastases in the sentinel node(s) have traditionally proceeded to completion of axillary node dissection, whereas patients who are node negative can be spared the morbidity of this procedure. Recently, there has been some debate as to what constitutes node-positive disease and whether patients with metastasis in the sentinel node(s) require completion axillary dissection. This review addresses the controversies regarding the management of sentinel node-positive breast cancer patients.
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Affiliation(s)
- Anees B Chagpar
- Division of Surgical Oncology Director, JG Brown Cancer Center Multidisciplinary Breast Program, University of Louisville, 312 East Broadway, Suite #314, Louisville, KY 40202, USA.
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Greenberg CC, Bafford AC, Golshan M. Is axillary dissection needed in node-positive breast cancer? Expert Rev Anticancer Ther 2014; 8:195-8. [DOI: 10.1586/14737140.8.2.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goodman S, O'Connor A, Kandil D, Khan A. The Ever-Changing Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer. Arch Pathol Lab Med 2014; 138:57-64. [DOI: 10.5858/arpa.2012-0441-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Axillary nodal status remains one of the most important prognostic indicators in the management of breast cancer. Axillary node metastases are seen in fewer than half of breast cancer cases, and axillary lymph node dissection is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) has become the gold standard for axillary staging of breast cancer.
Objective.—To present a detailed review of the existing studies on SLNB in relation to the various techniques, the pathologic evaluation of the sentinel node, and special situations that can involve SLNB. We discuss recent trials that have already had an influence on surgical and pathologic management of breast cancer. In this article, we also discuss our practice and experience at UMass Memorial Medical Center, Worcester, Massachusetts, from a pathologic and surgical perspective.
Data Sources.—Published articles from peer-reviewed journals in PubMed (US National Library of Medicine).
Conclusions.—Sentinel node biopsy has become standard of care in the surgical management of breast cancer, and emerging data show that the survival benefits of axillary lymph node dissection may not be greater than sentinel node biopsy alone in patients with up to 2 positive sentinel nodes. Therefore, there have been recent changes to the role of intraoperative sentinel node evaluation, and an impact on overall breast cancer management.
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Affiliation(s)
- Steven Goodman
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Ashling O'Connor
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Dina Kandil
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Ashraf Khan
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
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Modèles prédictifs d’envahissement du ganglion non sentinelle en cas de ganglion sentinelle positif dans le cancer du sein. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shah-Khan M, Boughey JC. Evolution of axillary nodal staging in breast cancer: clinical implications of the ACOSOG Z0011 trial. Cancer Control 2013; 19:267-76. [PMID: 23037494 DOI: 10.1177/107327481201900403] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Management of the axilla in breast cancer patients has evolved from routine axillary lymph node dissection (ALND) for all patients to a highly selective approach based on the assessment of the sentinel lymph nodes (SLNs) as well as tumor and patient characteristics. Although ALND continues to have an important role in staging and regional control for many breast cancer patients, recent trial results question the need for routine ALND in patients who have positive SLNs. METHODS Not all axillary disease becomes clinically detectable or relevant with respect to recurrence and survival. Therefore, recent trends indicate that many surgeons have omitted ALND in subgroups of patients, particularly those with clinically node-negative, SLN-positive, early-stage breast cancer undergoing breast-conserving therapy with postoperative irradiation. This review explores trends in axillary management, focusing primarily on the clinical implications of the results from the American College of Surgeons Oncology Group (ACOSOG) Z0011 randomized controlled trial. RESULTS According to the results of the ACOSOG Z0011 trial, the use of SLN dissection alone did not result in inferior survival compared with ALND in patients with limited SLN disease treated with breast-conserving therapy. This subgroup of women was spared the morbidity associated with ALND. However, several points of debate, including the smaller than anticipated sample size, the older study population, and the length of follow-up, suggest caution when applying these findings to all women with breast cancer. CONCLUSIONS Although the findings of ACOSOG Z0011 are impressive, in clinical practice they are applicable to a limited number of women with breast cancer: those with T1-2 primary tumors with clinically negative axilla and 1 to 2 positive SLNs undergoing breast-conserving surgery and adjuvant whole-breast irradiation. The next generation of clinical trials may answer some of the remaining questions regarding how best to manage the axilla in additional subsets of patients undergoing treatment of breast cancer.
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Affiliation(s)
- Miraj Shah-Khan
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Lee HS, Kim SW, Kim BH, Jung SY, Lee S, Kim TS, Kwon Y, Lee ES, Kang HS, Kim SK. Predicting Nonsentinel Lymph Node Metastasis Using Lymphoscintigraphy in Patients with Breast Cancer. J Nucl Med 2012; 53:1693-700. [DOI: 10.2967/jnumed.112.106260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Piñero A, Canteras M, Moreno A, Vicente F, Giménez J, Tocino A, Iglesias E, Vidal-Sicart S, Santamaría L, Lorenzo M, García M, Ramirez D. Multicenter validation of two nomograms to predict non-sentinel node involvement in breast cancer. Clin Transl Oncol 2012; 15:117-23. [DOI: 10.1007/s12094-012-0887-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/16/2012] [Indexed: 01/16/2023]
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31
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Pesce C, El-Tamer M. Does a positive sentinel lymph node always require completion dissection? BREAST CANCER MANAGEMENT 2012. [DOI: 10.2217/bmt.12.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Catherine Pesce
- Breast Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA
| | - Mahmoud El-Tamer
- Breast Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA
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Jones NB, Wakely PE, Klemanski DL, Al-Saif O, Young G, Frankel WL, Martin EW, Bloomston M. Cytopathologic evaluation of the in situ margin in patients undergoing hepatectomy. Cancer Cytopathol 2012; 120:410-5. [PMID: 22605571 DOI: 10.1002/cncy.21204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Margin status is a predictor of outcome for patients with liver malignancies, although what constitutes a negative margin is controversial. Traditionally, the completeness of resection is estimated by surgical histopathology of the resected specimen margin, despite the in situ margin being potentially more important. The true margin is often altered by parenchymal transection techniques. The authors propose that cytologic assessment of the in situ margin is more specific for determining the true margin. METHODS A total of 84 patients with primary or metastatic liver tumors who were undergoing surgical resection were enrolled in this prospective Institutional Review Board-approved study. Specimen and in situ (patient) margins were assessed using a "scrape preparation" cytologic technique and compared with traditional surgical histopathology. Patients were followed for assessment of local disease recurrence. RESULTS Follow-up data were complete for 64 patients for a median of 37 months (range, 12 months-56 months). Twenty patients were excluded because of perioperative death (6 patients; 7%) or a follow-up of < 12 months. Seven patients (12.2%) had positive histopathologic specimen margins, but only 1 was found to be positive by cytology (1.8%). No in situ cytologically positive margins were identified along the cut edge of the liver remnant. The rate of intra- or extrahepatic recurrences was 56.7%, whereas the local recurrence rate was 1.8%. One patient with local recurrence demonstrated simultaneous intra- and extrahepatic disease recurrences and had negative margins by all methods of evaluation. CONCLUSIONS To the authors' knowledge, the current study is the first to demonstrate that in situ margins can be assessed using cytopathology. This method is quick and can be universally applied. Given the difficulty of accurately assessing margins after hepatectomy, cytopathologic evaluation may be more reflective of the true margin. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.
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Affiliation(s)
- Natalie B Jones
- Department of Surgery, The Ohio State University, Columbus, OH 43210, USA
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Boler DE, Uras C, Ince U, Cabioglu N. Factors predicting the non-sentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases. Breast 2012; 21:518-23. [PMID: 22410110 DOI: 10.1016/j.breast.2012.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 02/02/2012] [Accepted: 02/19/2012] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE In a significant proportion of patients, the sentinel lymph node (SLN) is the only involved axillary node. The goal of the present study was to identify predictive factors associated with a positive SLN and with a positive non-SLN in patients in whom axillary lymph node dissection (ALND) was performed. METHODS Data was reviewed for patients with T1-2 invasive breast cancer who underwent SLN biopsy with or without axillary dissection in a single institution between July 2000 and May 2010. The SLNs were examined by serial sectioning and H&E staining, and by cytokeratin immunostaining in suspicious cases. RESULTS Of 332 patients with SLNB, 134 had SLN positivity, and 116 of them further underwent completion axillary dissection. Patients with T2 tumors (OR=3.2; 95% CI, 1.74-5.58), or tumors with lymphovascular invasion (OR=8.0; 95% CI, 4.44-14.27), or invasive ductal cancer (OR=2.92; 95% CI, 1.1-8.0) were more likely to have a positive SLN. In patients with ALND, the non-SLN involvement rates were 10%, 11.5% and 50% in patients with isolated tumor cells (ITC), micrometastasis and macrometastasis, respectively. Finding of ITC or micrometastasis in SLNs (OR=0.28; 95% CI, 0.08-0.99) or presence of extracapsular invasion (ECI) in SLN (OR=0.24; 95% CI, 0.09-0.67) were the predictive factors of not having a non-SLN metastasis in logistic regression analysis. CONCLUSIONS These findings suggest further axillary surgery can be best omitted in patients with micrometastasis while validation of nomograms including factors such as ECI are still needed to be studied in patients with macrometastasis.
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Affiliation(s)
- D E Boler
- Department of Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
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Berrang TS, Lesperance M, Truong PT, Walter C, Hayashi AH, Olivotto IA. Which prediction models best identify additional axillary disease after a positive sentinel node biopsy for breast cancer? Breast Cancer Res Treat 2012; 133:695-702. [DOI: 10.1007/s10549-012-1991-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 02/09/2012] [Indexed: 01/17/2023]
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van den Hoven I, Kuijt GP, Voogd AC, Roumen RMH. High Intersystem Variability for the Prediction of Additional Axillary Non-Sentinel Lymph Node Involvement in Individual Patients with Sentinel Node-Positive Breast Cancer. Ann Surg Oncol 2011; 19:1841-9. [DOI: 10.1245/s10434-011-2169-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Indexed: 01/17/2023]
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Sasada T, Murakami S, Kataoka T, Ohara M, Ozaki S, Okada M, Ohdan H. Memorial Sloan-Kettering Cancer Center Nomogram to predict the risk of non-sentinel lymph node metastasis in Japanese breast cancer patients. Surg Today 2011; 42:245-9. [DOI: 10.1007/s00595-011-0088-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/02/2011] [Indexed: 01/17/2023]
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Chen K, Zhu L, Jia W, Rao N, Fan M, Huang H, Shan Q, Han J, Song E, Zeng Y, Su F. Validation and comparison of models to predict non-sentinel lymph node metastasis in breast cancer patients. Cancer Sci 2011; 103:274-81. [DOI: 10.1111/j.1349-7006.2011.02148.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Iwuchukwu O, Wahed S, Wozniak A, Dordea M, Rich A. Recent advances in non-invasive axillary staging for breast cancer. Surg Oncol 2011; 20:253-8. [DOI: 10.1016/j.suronc.2010.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/21/2010] [Accepted: 05/31/2010] [Indexed: 01/17/2023]
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Salhab M, Patani N, Mokbel K. Sentinel lymph node micrometastasis in human breast cancer: an update. Surg Oncol 2011; 20:e195-206. [PMID: 21788132 DOI: 10.1016/j.suronc.2011.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 06/01/2011] [Accepted: 06/29/2011] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The advent of sentinel lymph node biopsy (SLNB) and advances in histopathological and molecular analysis techniques have been associated with an increase in micrometastasis (MM) detection rate. However, the clinical significance of sentinel lymph node micrometastasis (SLN MM) continues to be a subject of much debate. In this article we review the literature concerning SLN MM, with particular emphasis on the prognostic significance of SLN MM. The controversies regarding histopathological assessment, clinical relevance and management implications are also discussed. METHODS Literature review facilitated by Medline and PubMed databases. Cross referencing of the obtained articles was used to identify other relevant studies. RESULTS Published studies have reported divergent and rather conflicting results regarding the clinical significance and implications of axillary lymph node (ALN) MM in general and SLN MM in particular. Some earlier studies demonstrated no associations, however most recent studies have found SLN MM to be an indicator of poorer prognosis and to be associated with non-SLN involvement. The use of adjuvant chemotherapy and/or hormonal manipulation therapy is associated with an improved survival in patients with SLN MM. Complete ALND may be safely omitted provided that adjuvant systemic therapy recommendations are equal to patients with node-positive disease. However, optimal management of SLN MM is yet to conclude. Furthermore, the identification of MM remains largely dependent on the analytical technique employed and the use of immunohistochemistry (IHC) increases the detection rate of SLN MM. Discrepancies in the histopathological interpretation of TNM classification of SLN tumour burden do exist. Published studies were non-randomized and have significant limitations including a small sample size, limited follow-up period, and lack of standardization and reproducibility of pathological examination of the SLN. CONCLUSION Patients with SLN MM have a poorer prognosis than those who are SLN negative. Therapeutic recommendations regarding patients with SLN MM should be taken in the context of multidisciplinary team setting and in selected cases of SLN MM, complete ALND may be safely omitted. A better reproducibility of pathological interpretation of the TNM classification is required so that future therapeutic guidelines can be applied without confusion.
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Affiliation(s)
- Mohamed Salhab
- London Breast Institute, The Princess Grace Hospital, 45 Nottingham Place, London W1U 5NY, UK
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D’Eredita’ G, Troilo VL, Fischetti F, Rubini G, Berardi T. Comparison of two models for predicting non-sentinel lymph node metastases in sentinel lymph node-positive breast cancer patients. Updates Surg 2011; 63:163-70. [DOI: 10.1007/s13304-011-0079-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 05/02/2011] [Indexed: 01/17/2023]
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Validation of a nomogram for predicting overall survival after resection of pulmonary metastases from colorectal cancer at a single center. World J Surg 2011; 34:2973-8. [PMID: 20703466 DOI: 10.1007/s00268-010-0745-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The goal of this study was to validate a survival nomogram at a single center, originally developed at multiple institutions in Japan, which combines readily available preoperative variables to predict overall survival after resection of pulmonary metastases from colorectal cancer. METHODS An external patient cohort from a prospective pulmonary metastases database at the Aichi Cancer Center in Japan was used to test the validity of the pulmonary metastases from a colorectal cancer nomogram. The cohort included 58 consecutive patients who had surgery between January 1999 and December 2005. Nomogram predictions for 3- and 5-year overall survival were calculated for each patient and compared with actual survival. The concordance index was used as an accuracy measure. RESULTS Data for all necessary variables were available for all patients. At the last follow-up, 30 patients were alive, with a median follow-up of 39 (range, 5-94) months. The 1-, 2-, 3-, and 5-year overall survival rates were 96.6, 84.5, 70.5, and 48.9%, respectively. The nomogram concordance index was 0.81 with excellent calibration for both 3- and 5-year overall survival rates. CONCLUSIONS The high predictive accuracy of pulmonary metastases from a colorectal cancer nomogram demonstrates that this predictive tool derived at multiple institutions can be applied to a small cohort of patients in a single center.
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Fougo JL, Senra FS, Araújo C, Dias T, Afonso M, Leal C, Dinis-Ribeiro M. Validating the MSKCC nomogram and a clinical decision rule in the prediction of non-sentinel node metastases in a Portuguese population of breast cancer patients. Breast 2011; 20:134-40. [DOI: 10.1016/j.breast.2010.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 05/17/2010] [Accepted: 10/21/2010] [Indexed: 01/17/2023] Open
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van la Parra RFD, Peer PGM, Ernst MF, Bosscha K. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol 2011; 37:290-9. [PMID: 21316185 DOI: 10.1016/j.ejso.2011.01.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/15/2010] [Accepted: 01/04/2011] [Indexed: 01/17/2023] Open
Abstract
AIMS A meta-analysis was performed to identify the clinicopathological variables most predictive of non-sentinel node (NSN) metastases when the sentinel node is positive. METHODS A Medline search was conducted that ultimately identified 56 candidate studies. Original data were abstracted from each study and used to calculate odds ratios. The random-effects model was used to combine odds ratios to determine the strength of the associations. FINDINGS The 8 individual characteristics found to be significantly associated with the highest likelihood (odds ratio >2) of NSN metastases are SLN metastases >2mm in size, extracapsular extension in the SLN, >1 positive SLN, ≤1 negative SLN, tumour size >2cm, ratio of positive sentinel nodes >50% and lymphovascular invasion in the primary tumour. The histological method of detection, which is associated with the size of metastases, had a correspondingly high odds ratio. CONCLUSIONS We identified 8 factors predictive of NSN metastases that should be recorded and evaluated routinely in SLN databases. These factors should be included in a predictive model that is generally applicable among different populations.
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Affiliation(s)
- R F D van la Parra
- Department of Surgery, Gelderse Vallei Hospital, 6716 RP Ede, The Netherlands.
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D'Eredità G, Troilo VL, Giardina C, Napoli A, Rubini G, Fischetti F, Berardi T. Sentinel Lymph Node Micrometastasis and Risk of Non–Sentinel Lymph Node Metastasis: Validation of Two Breast Cancer Nomograms. Clin Breast Cancer 2010; 10:445-51. [DOI: 10.3816/cbc.2010.n.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
As most solid tumors, surgery is often the first step of the multidisciplinary management for breast cancers. Although mastectomy and axillar lymphadenectomy still have indications, conservative treatment and sentinel node detection are commonly used. Thanks to induction chemotherapy and oncoplastic techniques, surgery is conservative in most cases, even for important tumors without overall survival prejudice. There is no consensus about resection margins status but a limit of 2 to 3 mm seems to be reasonable while oncoplastic surgery allows large resection and good cosmetic outcomes. In this overview, we present the state of the art for breast cancer surgery including conservative and radical treatments, axillar lymphadenectomy and sentinel lymph node detection, margins status, oncoplastic techniques.
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Hwang RF, Giuliano A, Sahin A, Feldman S, Van Zee K. Regional Management of Breast Cancer. Ann Surg Oncol 2010; 17 Suppl 3:226-9. [DOI: 10.1245/s10434-010-1234-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Indexed: 01/24/2023]
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Moghaddam Y, Falzon M, Fulford L, Williams NR, Keshtgar MR. Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer. Br J Surg 2010; 97:1646-52. [DOI: 10.1002/bjs.7181] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract
Background
Women with breast cancer and a positive axillary sentinel lymph node (SLN) are recommended to undergo complete axillary lymph node dissection; however, further nodal disease is not always present. Mathematical models have been constructed to determine the risk of metastatic disease; three of these were evaluated independently.
Methods
Data from 108 women with breast cancer who had a positive SLN biopsy and completion axillary lymph node dissection were used. Measurements of additional parameters over those usually determined (such as size of SLN metastasis) were assessed under the supervision of two pathologists. These data were used to determine the predicted risk of non-SLN metastases using three mathematical models (from Memorial Sloan-Kettering Cancer Center (MSKCC), Cambridge University and Stanford University) and a comparison made with the observed findings. Analyses were made using the area under the receiver operating characteristic (ROC) curve (AUC).
Results
Some 53 (49·1 per cent) of 108 patients had a positive non-sentinel axillary lymph node metastasis. The AUC values were 0·63, 0·72 and 0·67 for the MSKCC, Cambridge and Stanford nomograms respectively.
Conclusion
This independent comparison found no significant difference between the models, although the Cambridge model had the advantage of requiring fewer measurements with a more accurate predictive performance.
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Affiliation(s)
- Y Moghaddam
- Department of Histopathology, University College Hospital, London, UK
| | - M Falzon
- Department of Histopathology, University College Hospital, London, UK
| | - L Fulford
- Department of Histopathology, University College Hospital, London, UK
| | - N R Williams
- Department of Surgery, University College London Medical School, London, UK
| | - M R Keshtgar
- Department of Surgery, University College London Medical School, London, UK
- Department of Surgery, Royal Free Hospital, London, UK
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van den Hoven I, Kuijt GP, Voogd AC, van Beek MWPM, Roumen RMH. Value of Memorial Sloan-Kettering Cancer Center nomogram in clinical decision making for sentinel lymph node-positive breast cancer. Br J Surg 2010; 97:1653-8. [DOI: 10.1002/bjs.7186] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract
Background
The aim of this study was to determine the value of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram for individual decision making in a Dutch cohort of women with breast cancer with a positive sentinel lymph node (SLN) but at low risk of additional nodal metastases.
Methods
Data were collected on 168 patients with a positive SLN who underwent completion axillary lymph node dissection. The predicted probability of non-SLN metastases was calculated for each patient, using the MSKCC nomogram. Specificity and false-negative rates were calculated for subgroups with a predicted risk of no more than 5, 10 or 15 per cent. A receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) calculated.
Results
The discrimination of the MSKCC nomogram, measured by the AUC, was 0·68. For low predicted probability cut-off values of no more than 5, 10 and 15 per cent, the false-negative rates were 20, 14 and 19 per cent, and the specificities were 4, 27 and 32 per cent, respectively. The low-risk category (5 per cent or less) consisted of only 3·0 per cent of the study population.
Conclusion
The performance of the MSKCC nomogram was insufficient to make it a useful tool for individual decision making in this cohort of women with SLN-positive breast cancer.
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Affiliation(s)
- I van den Hoven
- Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | - G P Kuijt
- Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | - A C Voogd
- Eindhoven Cancer Registry, Eindhoven, and Maastricht University Medical Centre, School GROW, Maastricht, The Netherlands
| | - M W P M van Beek
- Laboratory for Pathology and Medical Microbiology, Eindhoven, The Netherlands
| | - R M H Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
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Clinical Significance of Minimal Sentinel Node Involvement and Management Options. Surg Oncol Clin N Am 2010; 19:493-505. [DOI: 10.1016/j.soc.2010.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Kumar S, Bramlage M, Jacks LM, Goldberg JI, Patil SM, Giri DD, Van Zee KJ. Minimal Disease in the Sentinel Lymph Node: How to Best Measure Sentinel Node Micrometastases to Predict Risk of Additional Non-Sentinel Lymph Node Disease. Ann Surg Oncol 2010; 17:2909-19. [DOI: 10.1245/s10434-010-1115-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 01/17/2023]
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