| Breast sentinel lymph node (SLN) is the first lymph node that accepts the entirebreast lymphatic drainage, and it is the first lymph node that occurs metastasis. Thesentinel lymph node biopsy (SLNB) is the milestone in the development of breastsurgery. It is easy to operate and have low trauma. It can accurately predict the statusof axillary lymph node (ALN).It can be used as the method of axillary stagingevaluation. The current consensus is when the sentinel lymph node biopsy result isnegative, the risk of axillary lymph node metastasis is very low, so it do not needaxillary lymph node dissection (ALND).And when the sentinel lymph node biopsyresult is positive, it need axillary lymph node dissection. But a large part of patientsdo not have axillary lymph node metastasis, who is not necessary to have axillarylymph node dissection, but has brought many postoperative complications, such asupper extremity lymph edema, the the shoulder movement disorders, the inside ofthe forearm numbness and pain.The objective purpose of surgical treatment of breast cancer is to minimizesurgical resection, to improve the patient’s quality of life and to improve the survivalrate. With the development of basic medical research, application of newtechnologies is making the surgical treatment of breast cancer to a more small-scaledevelopment. Discern what sentinel lymph node-positive breast cancer patients havea very low risk of axillary metastasis, which can avoid axillary lymph nodedissection, is always the focus of breast surgery attention. Axillary sentinel lymphnode-positive breast cancer patients with low risk transfer only have sentinel lymphnode biopsy, which can reduce postoperative complications, improve quality of life,reduce hospital costs and length of hospital stay.ObjectiveTo research the risk factors for non-sentinel lymph node metastasis of positivesentinel lymph node in breast cancer patients. To validate the value of the MemorialSloan Kettering Cancer Center (MSKCC) nomogram for the prediction of NSLNmetastasis in the patients with breast cancer. MethodsCollect the cases who had sentinel lymph node biopsy successfully and theresults were positive in the People’s Liberation Army307Hospital from January2000to March2011, then have axillary lymph node dissection, a total of175cases.All cases meet the following criteria:①clinicaland radiographic examinations showed negative axillary;②preoperative pathology is breast cancer;③no preoperative chemotherapy, no preoperative radiationtherapy;④sentinel lymph node biopsy were found at least one sentinel lymph node metastasisand axillary lymph node dissection was supplemented.⑤signed an informed consent.The acquisition parameters include: patient age, primary tumor type, tumor size,nuclear grade, lymphatic invasion status, whether multiple tumors, tumor estrogenreceptor status, number of positive sentinel lymph node, the number of negativesentinel lymph node and axillary non-sentinel lymph node status.Cases was screened from175patients with breast cancer conforming theMSKCC model’s standard.Inclusion criteria:①pathological type of invasive lobular carcinoma, infiltrating ductal carcinoma,invasive mixed tumor;②the number of non-axillary sentinel lymph nodes that was cleared more than10.Exclusion criteria:①special type of invasive breast cancer (mucinous carcinoma, medullary carcinoma,adenocarcinoma, etc.) by a total of10cases;②the number of non-axillary sentinel lymph nodes that was cleared less than10, atotal of19cases.Lymph node-positive breast cancer patients were collected in line with the theMSKCC model calculations standard cases, it was collected a total of146cases from 179cases.Access the Internet http://www.mskcc.org/nomograms, using online freesoftware, enter one by one the size of the primary tumor, tumor type, lymphaticinvasion, multiple tumors, estrogen receptor status, outpost inspection methods, thenumber of positive sentinel node and the number of negative sentinel node,eightvariables.Calculated the rate of axillary non-sentinel lymph node metastasis risk foreach selected breast cancer patients.Receiver operating characteristic curve and areasunder the ROC curves were used to assess the resolving power of the MSKCCnomogram.ResultsTumor size, multiple tumors, the number of positive SLN, the number ofnegative SLN, positive sentinel lymph node transfer ratio were correlated with NSLNmetastasis. P value was0.0018、0.0029、0.0049、0.0007、0.0002respectively.Bymultivariate analysis, tumor size,multiple tumors,the number of positive SLN wereidentified as independent predictors of NSLN metastasis. The calibration curveshowed the same trend between the predictive value curve and the real valuecurve.The AUC of MSKCC nomogram was0.79.Scholars have conducted extensive research to accurately predict SLNmetastasis-positive patients NSLN transition state. The most analysis ofclinicopathological parameters are the size of the primary tumor, the state oflymphatic invasion and metastasis number of SLN, which have close relationshipbetween the state of axillary NSLN have been confirmed. The study also found thattumor size, SLN metastasis few pieces shifted positively correlated with NSLN. Onecase of vascular invasion, NSLN metastasis, compliance rate was100%. But thenumber of cases was small, no correlation was found in statistics. The study alsofound that many tumor metastasis was positively correlated with NSLN and negativeSLN metastasis few pieces were negatively correlated with NSLN. The results wasthe same with the existing prediction method.We recommend MSKCC nomogram in the way of SLN examination is changedto the sentinel lymph node metastasis size would be more appropriate. Anotherproblem of MSKCCC nomogram is that the existence of this model is only applicableto pathological type of invasive lobular carcinoma, infiltrating ductal carcinoma, invasive carcinoma mixed,which have lack of applicability to few special types ofinvasive breast cancer (mucinous carcinoma, medullary carcinoma, adenocarcinoma,etc.) The reason was special types of breast cancer was too few samples when theMSKCC nomogram was invented.ConclusionIn positive SLN breast cancer patients, primary tumor size, the number ofpositive sentinel lymph node, the number of negative sentinel lymph node, positivesentinel metastasis rate were associated with non-sentinel axillary lymph nodemetastasis. Multivariate logistic regression analysis further found that the size ofprimary tumor, whether multiple tumor and positive sentinel node number were theindependent risk factor for axillary metastasis.The MSKCC nomogram is appropriatefor our center as a useful tool to predict the risk of metastasis of axillary non-sentinellymph node accurately. It was proved that MSKCC nomogram had good metastasispredictive value about breast cancer patients with positive sentinel lymph node in ourresearch institutes. |
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