Nodal ratio and number of dissected nodes in breast cancer patients with inadequate axillary dissection

Abstract

Objective The aim of this study was to evaluate the prognostic significance and to define the optimal cutoff points of nodal ratio and number of dissected nodes in node-positive and node-negative breast cancer patients, respectively, who underwent inadequate axillary lymph node dissection (ALND). Background The absolute number of involved axillary lymph nodes (LNs) is considered the most important prognostic factor in breast cancer. Over the last decade, several studies indicated that the lymph node ratio (LNR) might predict outcome better than the number of positive LNs. Patients and methods This retrospective study included 200 women with invasive breast cancer. Group I included node-positive cases with inadequate ALND; group II included node-positive cases with adequate ALND; group III included node-negative cases with inadequate ALND; and group IV included node-negative cases with adequate ALND. Receiver operating characteristic curve was used to identify cutoff points of LNR in each of the node-positive groups, and number of dissected nodes in node-negative patients, classifying the patients into low-risk and high-risk groups. Results Optimal LNR cutoff points classifying node-positive patients into low-risk and high-risk groups were 0.44 for group I and 0.40 for group II with statistically significant differences in disease-free and overall survival. There were no statistically significant survival differences between groups III and IV. The cutoff point of six dissected nodes classified the node-negative patients into low-risk and high-risk groups with statistically significant differences in disease-free and overall survival. Conclusion LNR could be incorporated into the staging of breast cancer patients, especially those with inadequate axillary dissection. LNR cutoff points of 0.44 and 0.40 can be used to classify node-positive patients with inadequate and adequate axillary dissection, respectively, into low-risk and high-risk groups. For node-negative patients, oncologists can be satisfied with a number of dissected nodes as low as seven axillary LNs.