Abstract
Background:Axillary lymph node dissection (ALND) remains the standard of care in breast cancer patients with positive sentinel lymph node (SLN). However, approximately 40–60% of patients with positive SLNs have not developed to non-SLN metastasis and ALND seems to be an overtreatment. The purpose of this study was to analyze predictors and define a specific cut-off of total tumor load (TTL) of CK19 that can be used as a predictive factor of non-SLN metastasis in early breast cancer patients.Materials and Methods:The records of 238 patients with cT1-3N0 breast cancer who had an intraoperative SLN evaluation performed through One-Step nucleic acid (OSNA) assay at Songklanagarind Hospital between 1 January 2015 and 31 December 2019 were examined. Univariate and Multivariate analysis was used to identify clinicopathologic features in SLN-positive patients that predict metastasis to non-SLNs. Finally, receiver operative characteristics (ROC) curves were used to choose an optimal TTL cut-off value. Results:Of a total of 110 patients who had a positive SLN, only 48 (43.64%) were found to have positive nodes in non-SLN. Multivariate analysis revealed that lymphovascular invasion, type of SLN metastasis and SLN TTL (copies/μL) were independent predictors of positive non-SLNs. TTL cut-off value was 19,000 copies/μL, with an AUC of 0.838 with 72.7% sensitivity and 84.7% specificity to predict non-SLN metastasis. Conclusions:The likelihood of positive non-SLNs in patients who showed a positive SLN correlates with lymphovascular invasion, type of SLN metastasis and SLN TTL (copies/μL). Our result revealed that the patients with a SLN TTL ≥19,000 copies/µl continue to attract the recommendation to proceed with ALND. This cut-off value can then help clinicians to assess which patients would benefit from ALND.
Highlights
The diagnosis of lymph node metastasis is an important surgical procedure that will define the prognostics and treatment of breast cancer patients
Our result revealed that the patients with a sentinel lymph node (SLN) total tumor load (TTL) ≥19,000 copies/μl continue to attract the recommendation to proceed with Axillary lymph node dissection (ALND)
Previous studies revealed that 60.7% of the patients with macrometastatic SLN and 70.0% of patients with TTL in the SLN between 5,000 and 15,000 copies/μl had no further nodal involvement on ALND (Peg et al, 2013; Fung et al, 2017). These results indicated that approximately half of SLN-positive patients undergo unnecessary ALND and this cut-off value might lead to overdiagnosis of SLN metastasis status
Summary
The diagnosis of lymph node metastasis is an important surgical procedure that will define the prognostics and treatment of breast cancer patients. Axillary lymph node dissection (ALND) remains the standard of care in breast cancer patients with positive sentinel lymph node (SLN). The purpose of this study was to analyze predictors and define a specific cut-off of total tumor load (TTL) of CK19 that can be used as a predictive factor of non-SLN metastasis in early breast cancer patients. Univariate and Multivariate analysis was used to identify clinicopathologic features in SLN-positive patients that predict metastasis to non-SLNs. receiver operative characteristics (ROC) curves were used to choose an optimal TTL cut-off value. Our result revealed that the patients with a SLN TTL ≥19,000 copies/μl continue to attract the recommendation to proceed with ALND. This cut-off value can help clinicians to assess which patients would benefit from ALND
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