J Breast Cancer.  2017 Sep;20(3):270-278. 10.4048/jbc.2017.20.3.270.

Development of a Nomogram to Predict N2 or N3 Stage in T1–2 Invasive Breast Cancer Patients with No Palpable Lymphadenopathy

• Kim I
• Ryu JM
• Kim JM
• Choi HJ
• Lee SK
• Yu JH
• Lee JE
• Kim SW
• Nam SJ

• KMID: 2438994
• DOI: http://doi.org/10.4048/jbc.2017.20.3.270

Abstract

PURPOSE
Subsequent to the American College of Surgeons Oncology Group (ACOSOG) Z0011 and After Mapping of the Axilla: Radiotherapy or Surgery (AMAROS) trials, complete axillary lymph node dissection is not routinely performed, even in cases where metastatic sentinel lymph nodes are detected. We investigated the percentage of N2 or N3 stages in T1-2 invasive breast cancer patients with no lymphadenopathy and developed a nomogram to predict the possibility of N2 or N3 stages in these patients.
METHODS
We retrospectively reviewed the charts of invasive breast cancer patients who were clinically N0 stage, but had a positive sentinel or non-sentinel lymph node detected on sentinel lymph node biopsy. The association of potential risk factors with known outcomes (N2 or N3 stages) was tested using logistic regression analysis. Variables with p<0.05 in the multivariate analysis were included in the nomogram. Internal performance validation was carried out using a 5-fold cross validation method.
RESULTS
Among a total of 1,437 patients, 1,355 patients had stage N1 disease (94.3%), while 82 had stage N2 or N3 disease (5.7%). Multivariate stepwise logistic regression analysis revealed lymphovascular invasion (p=0.008), T2 stage (p=0.026), metastatic lymph node ratio (p<0.001), and perinodal extension (p<0.001) as independent predictors of N2 or N3 stages. A nomogram was developed based on these factors. The area under the curve estimated from the receiver operating characteristic graph was 0.8050 in the model set and 0.8246 in the test set.
CONCLUSION
Our nomogram can be employed for the prediction of N2 or N3 stage among cases fulfilling the ACOSOG Z0011 or AMAROS criteria.

Keyword

Breast neoplasms; Lymph node excision; Nomograms; Sentinel lymph node biopsy

MeSH Terms

Axilla
Breast Neoplasms*
Breast*
Humans
Logistic Models
Lymph Node Excision
Lymph Nodes
Lymphatic Diseases*
Methods
Multivariate Analysis
Nomograms*
Radiotherapy
Retrospective Studies
Risk Factors
ROC Curve
Sentinel Lymph Node Biopsy
Surgeons

Figure

• 

  Figure 1 Flow chart of the patient inclusion process.SLN=sentinel lymph node; SLNB=sentinel lymph node biopsy; LN=lymph node.

• 

  Figure 2 Nomogram to predict likelihood of N2 or N3 stage in clinical T1–2N0M0 breast cancer patients using four variables (metastasis node ratio, perinodal extension, lymphovascular invasion, and T stage).

• 

  Figure 3 The area under the curve of the receiver operating characteristic graph. (A) In the model set (0.8050) and (B) in the test set (0.8246).

• 

  Figure 4 Nomogram to predict likelihood of N2 or N3 stage in clinical T1–2N0M0 breast cancer patients including metastasis size data (metastasis size, metastasis node ratio, lymphovascular invasion, and T stage).

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