Abstract
BackgroundThe current management of the axilla in level 1 node-positive breast cancer patients is axillary lymph node dissection regardless of the status of the level 2 axillary lymph nodes. The goal of this study was to develop a nomogram predicting the probability of level 2 axillary lymph node metastasis (L-2-ALNM) in patients with level 1 axillary node-positive breast cancer.Materials and MethodsWe reviewed the records of 974 patients with pathology-confirmed level 1 node-positive breast cancer between 2010 and 2014 at the Liaoning Cancer Hospital and Institute. The patients were randomized 1:1 and divided into a modeling group and a validation group. Clinical and pathological features of the patients were assessed with uni- and multivariate logistic regression. A nomogram based on independent predictors for the L-2-ALNM identified by multivariate logistic regression was constructed.ResultsIndependent predictors of L-2-ALNM by the multivariate logistic regression analysis included tumor size, Ki-67 status, histological grade, and number of positive level 1 axillary lymph nodes. The areas under the receiver operating characteristic curve of the modeling set and the validation set were 0.828 and 0.816, respectively. The false-negative rates of the L-2-ALNM nomogram were 1.82% and 7.41% for the predicted probability cut-off points of < 6% and < 10%, respectively, when applied to the validation group.ConclusionsOur nomogram could help predict L-2-ALNM in patients with level 1 axillary lymph node metastasis. Patients with a low probability of L-2-ALNM could be spared level 2 axillary lymph node dissection, thereby reducing postoperative morbidity.
Highlights
Owing to its increasing incidence, breast cancer has become one of the most common malignancies, accounting for 15% of all cancer-related deaths [1,2,3]
For patients clinically diagnosed as having a level 1 axillary lymph node metastasis (L-1-ALNM), the standard surgical procedure includes primary tumor www.impactjournals.com/oncotarget resection and axillary lymph node dissection (ALND; including level 1 and 2 axillary lymph nodes), regardless of whether the level 2 axillary lymph node is positive or negative for malignancy
Omission of L-2ALND provides patients with better quality of life than performing ALND [8,9,10]. These findings suggest that a nomogram should be established urgently to evaluate the level 2 axillary lymph node status in patients with level 1 node-positive breast cancer and to identify those in whom L-2-ALND can be omitted
Summary
Owing to its increasing incidence, breast cancer has become one of the most common malignancies, accounting for 15% of all cancer-related deaths [1,2,3]. Level 1 axillary lymph node dissection could be a better option for patients with positive level 1 axillary lymph nodes but without L-2-ALNM. Omission of L-2ALND provides patients with better quality of life than performing ALND [8,9,10] These findings suggest that a nomogram should be established urgently to evaluate the level 2 axillary lymph node status in patients with level 1 node-positive breast cancer and to identify those in whom L-2-ALND can be omitted. The current management of the axilla in level 1 node-positive breast cancer patients is axillary lymph node dissection regardless of the status of the level 2 axillary lymph nodes. The goal of this study was to develop a nomogram predicting the probability of level 2 axillary lymph node metastasis (L-2-ALNM) in patients with level 1 axillary node-positive breast cancer
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