Abstract
BackgroundNon-sentinel lymph node (NSLN) status prediction with molecular biomarkers may make some sentinel lymph node (SLN) positive breast cancer patients avoid the axillary lymph node dissection, but the available markers remain limited.MethodsSLN positive patients with and without NSLN invasion were selected, and genes differentially expressed or fused in SLN metastasis were screened by next-generation RNA sequencing.ResultsSix candidates (all ER/PR+, HER2−, Ki-67 <20 %) with metastatic SLNs selected from 305 patients were equally categorized as NSLN negative and positive. We identified 103 specifically expressed genes in the NSLN negative group and 47 in the NSLN positive group. Among them, FABP1 (negative group) and CYP2A13 (positive group) were the only 2 protein-encoding genes with expression levels in the 8th to 10th deciles. Using a false discovery rate threshold of <0.05, 62 up-regulated genes and 98 down-regulated genes were discovered in the NSLN positive group. Furthermore, 10 gene fusions were identified in this group with the most frequently fused gene being IGLL5.ConclusionsThe biomarkers screened in present study may broaden our understanding of the mechanisms of breast cancer metastasis to the lymph nodes and contribute to the axillary surgery selection for SLN positive patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-015-0642-2) contains supplementary material, which is available to authorized users.
Highlights
Non-sentinel lymph node (NSLN) status prediction with molecular biomarkers may make some sentinel lymph node (SLN) positive breast cancer patients avoid the axillary lymph node dissection, but the available markers remain limited
If SLN is positive for metastasis, Axillary lymph node dissection (ALND) is still recommended to clarify the status of the remaining non-sentinel lymph nodes (NSLNs) in the axilla [8, 9]
Patient characteristics Sixty-nine SLN positive breast cancer patients were chosen from 305 patients who received sentinel lymph node biopsy (SLNB) between November 2010 and April 2013 at our hospital
Summary
Non-sentinel lymph node (NSLN) status prediction with molecular biomarkers may make some sentinel lymph node (SLN) positive breast cancer patients avoid the axillary lymph node dissection, but the available markers remain limited. In order to avoid the over-treatment suffering brought about by ALND, it has become imperative for breast cancer surgeons to find effective methods that can distinguish SLN positive patients with low probability of NSLN invasion from those with high probability of NSLN invasion Among these methods, predictive models based on retrospective analysis of patients’ clinical characteristics (e.g., age, histological type, tumor size, lymphovascular invasion, and hormone receptor status), such as the nomogram of Memorial Sloan-Kettering Cancer Center [12] and the scoring systems of MD Anderson [13], Tenon [14], Cambridge [15], and Stanford [16], were the most frequently mentioned ones. Some scientists were dedicated to search for biomarkers that can predict NSLN status [17,18,19,20,21,22,23], but until recently, the available choices remained limited and their practical value still needed additional verification
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