Validation of three breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy and design new formula

INTRODUCTIONAt present sentinel lymph node biopsy (SLNB) has become a standard procedure for staging and selecting the treatment of early stage breast cancer. Although patients who have positive SLNB should undergo to axillary lymph node dissection (ALND), about 40-70% of them have no nonsentinel lymph node (NSLN) metastasis. Therefore many patients undergo to unnecessary axillary dissection. SLNB gains importance because of ALND has some complications like seroma, lymphedema, nerve injury and frozen shoulder. Several institutions have developed nomograms to identify patients with a sufficiently low risk of nonsentinel lymph node metastasis to avoid completion axillary lymph node dissection.PURPOSEThe aim of the study is to evaluate the available breast nomograms (MSKCC, Stanford, Tenon) to predict non-sentinel lymph node metastasis (NSLNM) and to determine the variables on NSLNM in the SLN positive breast Cancer (BC) patients in the our population.METHODWe retrospectively reviewed BC patients who underwent SLN biopsy Between Jul 2008 and Aug 2010 in our hospital. One hundred and seventy SLN biopsy positive patients who had completion axillary lymph node dissection were evaluated. The patients who received neoadjuvant chemotherapy were excluded from the analysis. We described two groups; group one NSLN negative (70 patients), group two NSLN positive (100 patients).The variables documented included: patient age, pathologic size of the tumor in centimeters, nuclear grade and tumor type, SBR grade, the number of positive SLNs, the number of negative SLNs, the method of detection of SLNs [frozen section (FS), routine haematoxylin & eosin (HE), serial section haematoxylin & eeosin (SSHE) and immunohistochemistry (IHC)], estrogen receptor status, progesterone receptor status, lymphovascular invasion (LVI), elastosis, invasion of the skin, fascia and the vessels; metastatic tumor size [the largest size of SLN metastasis (macro metastasis, Keyword: Aksilla = Axilla ; Lenf nod eksizyonu = Lymph nodes-excision ; Lenf nodları = Lymph nodes ; Meme = Breast ; Meme neoplazmları = Breast neoplasms ; Neoplazm metastazları = Neoplasm metastasis ; Neoplazmlar = Neoplasms ; Neoplazmlar = Neoplasms ; Risk faktörleri = Risk factors