Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
PURPOSE: 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.
Abstract
PURPOSE: 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.
참고문헌 (30)
- Giuliano AE, "Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis : a randomized clinical trial", JAMA, 305, pp.569~575 (2011)
- Setton J, "Radiation field design and regional control in sentinel lymph node-positive breast cancer patients with omission of axillary dissection", Cancer, 118, pp.1994~2003 (2012)
- Taffurelli M, "Effectiveness of sentinel lymph node intraoperative examination in 753 women with breast cancer: are we overtreating patients", Ann Surg, 255, pp.976~980 (2012)
- Valente SA, "Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging", Ann Surg Oncol, 19, pp.1825~1830 (2012)
- Moon HG, "Underweight and breast cancer recurrence and death : a report from the Korean Breast Cancer Society", J Clin Oncol, 27, pp.5899~5905 (2009)
- Cho N, "Preoperative sonographic classification of axillary lymph nodes in patients with breast cancer : node-to-node correlation with surgical histology and sentinel node biopsy results", AJR Am J Roentgenol, 193, pp.1731~1737 (2009)
- Kim H, "The value of preoperative staging chest computed tomography to detect asymptomatic lung and liver metastasis in patients with primary breast carcinoma", Breast Cancer Res Treat, 126, pp.637~641 (2011)
- 한아람, "Reliability of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients", Journal of Breast Cancer, 16(4), pp.378~385 (2013), 한국유방암학회
- Iasonos A, "How to build and interpret a nomogram for cancer prognosis", J Clin Oncol, 26, pp.1364~1370 (2008)
- Cipolla C, "The value of intraoperative frozen section examination of sentinel lymph nodes in surgical management of breast carcinoma", Langenbecks Arch Surg, 395, pp.685~691 (2010)
- Schwartz GF, "Value of intraoperative examination of axillary sentinel nodes in carcinoma of the breast", J Am Coll Surg, 207, pp.758~762 (2008)
- Liu W, "Intraoperative detection of sentinel lymph node metastases from breast cancer: does the pathologist experience, subspecialty or the surgeon experience matter", Lab Invest, 90, pp.59A~ (2010)
- Weber WP, "A 10-year trend analysis of sentinel lymph node frozen section and completion axillary dissection for breast cancer: are these procedures becoming obsolete", Ann Surg Oncol, 19, pp.225~232 (2012)
- Chan SW, "Does the benefit of sentinel node frozen section vary between patients with invasive duct, invasive lobular, and favorable histologic subtypes of breast cancer", Ann Surg, 247, pp.143~149 (2008)
- Chao C, "Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer", Am J Surg, 182, pp.609~615 (2001)
- Tanis PJ, "Frozen section investigation of the sentinel node in malignant melanoma and breast cancer", Ann Surg Oncol, 8, pp.222~226 (2001)
- Weiser MR, "Is routine intraoperative frozen-section examination of sentinel lymph nodes in breast cancer worthwhile?", Ann Surg Oncol, 7, pp.651~655 (2000)
- Rahusen FD, "The implementation of the sentinel node biopsy as a routine procedure for patients with breast cancer", Surgery, 128, pp.6~12 (2000)
- Veronesi U, "Sentinel lymph node biopsy and axillary dissection in breast cancer : results in a large series", J Natl Cancer Inst, 91, pp.368~373 (1999)
- Noguchi M, "Staging efficacy of breast cancer with sentinel lymphadenectomy", Breast Cancer Res Treat, 57, pp.221~229 (1999)
- Canavese G, "Sentinel lymph node mapping opens a new perspective in the surgical management of early-stage breast cancer : a combined approach with vital blue dye lymphatic mapping and radioguided surgery", Semin Surg Oncol, 15, pp.272~277 (1998)
- McLaughlin SA, "Influence of frozen-section analysis of sentinel lymph node and lumpectomy margin status on reoperation rates in patients undergoing breast-conservation therapy", J Am Coll Surg, 206, pp.76~82 (2008)
- Pamilo M, "Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients", J Ultrasound Med, 8, pp.115~120 (1989)
- Nori J, "Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy", Am J Surg, 193, pp.16~20 (2007)
- Lee MC, "Consequences of axillary ultrasound in patients with T2 or greater invasive breast cancers", Ann Surg Oncol, 18, pp.72~77 (2011)
- March DE, "CT-pathologic correlation of axillary lymph nodes in breast carcinoma", J Comput Assist Tomogr, 15, pp.440~444 (1991)
- Peare R, "The use of FDG-PET in assessing axillary lymph node status in breast cancer : a systematic review and meta-analysis of the literature", Breast Cancer Res Treat, 123, pp.281~290 (2010)
- Kvistad KA, "Axillary lymph node metastases in breast cancer : preoperative detection with dynamic contrast-enhanced MRI", Eur Radiol, 10, pp.1464~1471 (2000)
- Yoshimura G, "Evaluation of axillary lymph node status in breast cancer with MRI", Breast Cancer, 6, pp.249~258 (1999)
- Houssami N, "Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer : meta-analysis of its accuracy and utility in staging the axilla", Ann Surg, 254, pp.243~251 (2011)