The American Journal of Surgery
Volume 194, Issue 3 , Pages 288-293 , September 2007

Validation of clinical prediction rules for a low probability of nonsentinel and extensive lymph node involvement in breast cancer patients

  • Gábor Cserni, M.D., Ph.D., D.Sc.

      Affiliations

    • Department of Surgical Pathology, Bács-Kiskun County Teaching Hospital, Nyiri út 38, H-6000 Kecskemét, Hungary
    • Corresponding Author InformationCorresponding author. Tel.: +36-76-516768; fax: +36-76-481219.
  • ,
  • Simonetta Bianchi, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
  • ,
  • Vania Vezzosi, M.D., Ph.D.

      Affiliations

    • Department of Human Pathology and Oncology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
  • ,
  • Riccardo Arisio, M.D., Ph.D.

      Affiliations

    • Department of Pathology, Sant’Anna Hospital, Turin, Corso Spezia 60, 10126 Italy
  • ,
  • Johannes L. Peterse, M.D.

      Affiliations

    • Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
  • ,
  • Anna Sapino, M.D.

      Affiliations

    • Department of Biological Science and Human Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy
  • ,
  • Isabella Castellano, M.D., Ph.D.

      Affiliations

    • Department of Biological Science and Human Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy
  • ,
  • Maria Drijkoningen, M.D., Ph.D.

      Affiliations

    • Pathologische Ontleedkunde, University Hospitals, Minderbroedersstrasse 12, B-3000 Leuven, Belgium
  • ,
  • Janina Kulka, M.D., Ph.D.

      Affiliations

    • 2nd Institute of Pathology, Semmelweis University, Faculty of Medicine, Ulloi ut 93, H-1091 Budapest, Hungary
  • ,
  • Vincenzo Eusebi, M.D., F.R.C.Path.

      Affiliations

    • Sezione Anatomia Patologica M. Malpighi, Universita di Bologna, Ospedale Bellaria, Via Altura 3, 40139 Bologna, Italy
  • ,
  • Maria P. Foschini, M.D.

      Affiliations

    • Sezione Anatomia Patologica M. Malpighi, Universita di Bologna, Ospedale Bellaria, Via Altura 3, 40139 Bologna, Italy
  • ,
  • Jean-Pierre Bellocq, M.D.

      Affiliations

    • Service d’Anatomie Pathologique, Hopital de Hautepierre, Avenue Moliere, F-67098 Strasbourg, France
  • ,
  • Cristi Marin, M.D.

      Affiliations

    • Service d’Anatomie Pathologique, Hopital de Hautepierre, Avenue Moliere, F-67098 Strasbourg, France
  • ,
  • Sten Thorstenson, M.D.

      Affiliations

    • Department of Pathology and Cytology, Kalmar Hospital, Länssjukhuset, S-39185 Kalmar, Sweden
  • ,
  • Isabel Amendoeira, M.D.

      Affiliations

    • Instituto de Patologia e Imunologia da Universidade do Porto (IPATIMUP) and Hospital de S. João, Rua Roberto Frias s/n, 4200 Porto, Portugal
  • ,
  • Angelika Reiner-Concin, M.D.

      Affiliations

    • Institute of Pathology, Donauspital, Langobardenstrasse 122, A-1220 Wien, Austria
  • ,
  • Thomas Decker, M.D.

      Affiliations

    • Gerhard-Domagk Institut fur Pathologie, Universitat von Munster, Domagkstrasse 17, D-48129 Munster, Germany
  • ,
  • Manuela Lacerda, M.D., Ph.D.

      Affiliations

    • Laboratorio De Histopatologica, Centro Regional De Oncologia De Coimbra, Avenida Bissaia Barreto 98, 3000 Coimbra, Portugal
  • ,
  • Paulo Figueiredo, M.D.

      Affiliations

    • Laboratorio De Histopatologica, Centro Regional De Oncologia De Coimbra, Avenida Bissaia Barreto 98, 3000 Coimbra, Portugal

Received 9 December 2006 ,Revised 1 February 2007

References 

  1. Giuliano AE, Dale PS, Turner RR, Morton DL, Evans SW, Krasne DL. Improved axillary staging of breast cancer with sentinel lymphadenectomy. Ann Surg. 1995;180:700–704
  2. Cserni G, Amendoeira I, Apostolikas N, et al. Pathological work-up of sentinel lymph nodes in breast cancer (Review of current data to be considered for the formulation of guidelines). Eur J Cancer. 2003;39:1654–1667
  3. Veronesi U, Galimberti V, Mariani L, et al. Sentinel node biopsy in breast cancer: early results in 953 patients with negative sentinel node biopsy and no axillary dissection. Eur J Cancer. 2005;41:231–237
  4. Schrenk P, Rieger R, Shamiyeh A, et al. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer. 2000;88:608–614
  5. Chagpar AB, McMasters KM. Treatment of node-positive breast cancer. Expert Rev Anticancer Ther. 2006;6:1233–1239
  6. Orr RK. The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis. Ann Surg Oncol. 1999;6:109–116
  7. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–2106
  8. Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection?. Ann Surg. 1999;229:536–541
  9. Reynolds C, Mick R, Donohue JH, et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer?. J Clin Oncol. 1999;17:1720–1726
  10. Weiser MR, Montgomery LL, Tan LK, et al. Lymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg Oncol. 2001;8:145–149
  11. De Widt-Levert L, Tjan-Heijnen V, Bult P, et al. Stage migration in breast cancer: surgical decisions concerning isolated tumour cells and micro-metastases in the sentinel lymph node. Eur J Surg Oncol. 2003;29:216–220
  12. Chua B, Ung O, Taylor R, et al. Treatment implications of a positive sentinel lymph node biopsy for patients with early-stage breast carcinoma. Cancer. 2001;92:1769–1774
  13. Teng S, Dupont E, McCann C, et al. Do cytokeratin-positive-only sentinel lymph nodes warrant complete axillary lymph node dissection in patients with invasive breast cancer?. Am Surg. 2000;66:574–578
  14. Mignotte H, Treilleux I, Faure C, et al. Axillary lymph-node dissection for positive sentinel nodes in breast cancer patients. Eur J Surg Oncol. 2002;28:623–626
  15. den Bakker MA, van Weeszenberg A, de Kanter AY, et al. Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance. J Clin Pathol. 2002;55:932–935
  16. Nos C, Harding-MacKean C, Freneaux P, et al. Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastases. Br J Surg. 2003;90:1354–1360
  17. Travagli JP, Atallah D, Mathieu MC, et al. Sentinel lymphadenectomy without systematic axillary dissection in breast cancer patients: predictors of non-sentinel lymph node metastasis. Eur J Surg Oncol. 2003;29:403–406
  18. Viale G, Maiorano E, Pruneri G, et al. Predicting the risk for additional axillary metastases in patients with breast carcinoma and positive sentinel lymph node biopsy. Ann Surg. 2005;241:319–325
  19. Rahusen FD, Torrenga H, van Diest PJ, et al. Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg. 2001;136:1059–1063
  20. Recht A, Edge SB. Evidence-based indications for postmastectomy irradiation. Surg Clin North Am. 2003;83:995–1013
  21. Harris JR, Halpin-Murphy P, McNeese M, et al. Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys. 1999;44:989–990
  22. Pomahac B, Recht A, May JW, et al. New trends in breast cancer management: is the era of immediate breast reconstruction changing?. Ann Surg. 2006;244:282–288
  23. Chagpar AB, Scoggins CR, Martin RCG, et al. Prediction of sentinel lymph node-only disease in women with invasive breast cancer. Am J Surg. 2006;192:882–887
  24. Chagpar AB, Scoggins CR, Martin RCG, et al. Predicting patients at low probability of requiring postmastectomy radioation therapy. Ann Surg Oncol. 2007;14:670–677
  25. Lowry R. Simple ROC curve analysis: version 1. In: Lowry R, ed. VassarStats. Poughkeepsie, NY: Vassar College. Available at: http://departments.vassar.edu/∼lowry/VassarStats.html. Accessed October 29, 2006.
  26. Tape TG. The area under an ROC curve. In: Tape TG, ed. Interpreting Diagnostic Tests. Omaha, NE: University of Nebraska Medical Center. Available at: http://gim.unmc.edu/dxtests/ROC3.htm. Accessed October 29, 2006.
  27. Cserni G. What is a positive sentinel lymph node in breast cancer patients? (A practical approach). Breast. 2007;16:152–160
  28. Hermanek P, Hutter RVP, Sobin LH, Wittekind C. Classification of isolated tumor cells and micrometastasis. Cancer. 1999;86:2668–2673
  29. In:  Sobin LH,  Wittekind C editor. UICC TNM Classification of Malignant Tumours. 6th ed.. New York: John Wiley and Sons, Inc; 2002;
  30. In:  Greene FL,  Page DL,  Fleming ID, et al. editor. AJCC Cancer Staging Handbook—TNM Classification of Malignant Tumors. 6th ed.. New York: Springer Verlag; 2002;
  31. Singletary SE, Greene FL, Sobin LH. Classification of isolated tumor cells: clarification of the 6th edition of the American Joint Committee on Cancer Staging Manual. Cancer. 2003;98:2740–2741
  32. Cserni G, Bianchi S, Boecker W, et al. Improving the reproducibility of diagnosing micrometastases and isolated tumor cells. Cancer. 2005;103:358–367
  33. Cserni G, Sapino A, Decker T. Discriminating between micrometastases and isolated tumor cells in a regional and institutional setting. Breast. 2006;15:347–354
  34. Van Zee KJ, Manasseh DME, Bevilacqua JLB, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patient with a positive sentinel node biopsy. Ann Surg Oncol. 2003;10:1140–1151
  35. Kocsis L, Svebis M, Boross G, et al. Use and limitations of a nomogram predicting the likelihood of non-sentinel node involvement after a positive sentinel node biopsy in breast cancer patients. Am Surg. 2004;70:1019–1024
  36. Smidt ML, Kuster DM, van der Wilt GJ, et al. Can the Memorial Sloan-Kettering Cancer Center nomogram predict the likelihood of nonsentinel lymph node metastases in breast cancer patients in the Netherlands?. Ann Surg Oncol. 2005;12:1066–1072
  37. Soni NK, Carmalt HL, Gillett DJ, Spillane AJ. Evaluation of a breast cancer nomogram for prediction of non-sentinel lymph node positivity. Eur J Surg Oncol. 2005;31:958–964
  38. Degnim AC, Reynolds C, Pantvaidya G, et al. Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram. Am J Surg. 2005;190:543–550
  39. Lambert LA, Ayers GD, Hwang RF, et al. Validation of a breast cancer nomogram for predicting nonsentinel lymph node metastases after a positive sentinel node biopsy. Ann Surg Oncol. 2006;13:310–320
  40. Cripe MH, Beran LC, Liang WC, Sickle-Santanello BJ. The likelihood of additional nodal disease following a positive sentinel lymph node biopsy in breast cancer patients: validation of a nomogram. Am J Surg. 2006;192:484–487
  41. Cserni G. Comparison of different validation studies on the use of the Memorial-Sloan Kettering Cancer Center nomogram predicting nonsentinel node involvement in sentinel node positive breast cancer patients. Am J Surg (in press)
  42. Degnim AC, Griffith KA, Sabel MS, et al. Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast cancer patients. Cancer. 2003;98:2307–2315

PII: S0002-9610(07)00453-9

doi: 10.1016/j.amjsurg.2007.02.014

The American Journal of Surgery
Volume 194, Issue 3 , Pages 288-293 , September 2007