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KMID : 0939920170490041088
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대한암학회지
2017 Volume.49 No. 4 p.1088 ~ p.1096
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Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery
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Ahn Soo-Kyung
Kim Min-Kyoon
Kim Jong-Jin
Lee Eun-Shin
Yoo Tae-Kyung
Lee Han-Byoel
Kang Young-Joon
Kim Ji-Sun
Moon Hyeong-Gon
Chang Jung-Min
Cho Na-Ri-Ya
Moon Woo-Kyung
Park In-Ae
Noh Dong-Young
Han Won-Shik
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Abstract
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Purposep: The American College of Surgeons Oncology Group Z0011 trial reported that complete dissection of axillary lymph nodes (ALNs) may not be warranted in women with clinical T1-T2 tumors and one or two involved ALNs who were undergoing lumpectomy plus radiation followed by systemic therapy. The present study was conducted to identify preoperative imaging predictors of ≥ 3 ALNs.
Materials and Methods: The training set consisted of 1,917 patients with clinical T1-T2 and node negative invasive breast cancer. Factors associated with ≥ 3 involved ALNs were evaluated by logistic regression analysis. The validation set consisted of 378 independent patients. The nomogram was applied prospectively to 512 patients who met the Z0011 criteria.
Results: Of the 1,917 patients, 204 (10.6%) had ≥ 3 positive nodes. Multivariate analysis showed that involvement of ≥ 3 nodes was significantly associated with ultrasonographic and chest computed tomography findings of suspicious ALNs (p < 0.001 each). These two imaging criteria, plus patient age, were used to develop a nomogram calculating the probability of involvement of ≥ 3 ALNs. The areas under the receiver operating characteristic curve of the nomogram were 0.852 (95% confidence interval [CI], 0.820 to 0.883) for the training set and 0.896 (95% CI, 0.836 to 0.957) for the validation set. Prospective application of the nomogram showed that 60 of 512 patients (11.7%) had scores above the cut-off. Application of the nomogram reduced operation time and cost, with a very low re-operation rate (1.6%).
Conclusion: Patients likely to have ≥ 3 positive ALNs could be identified by preoperative imaging. The nomogram was helpful in selective intraoperative examination of sentinel lymph nodes.
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KEYWORD
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Sentinel lymph node, Nomograms, Z0011, Breast neoplasms, Chest, Computed tomography, Axilla sonography
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