Abstract
A negative sentinel lymph node (SLN) biopsy spares many breast cancer patients the complications associated with lymph node irradiation or additional surgery. However, patients at high risk for nodal involvement based on clinical characteristics may remain at unacceptably high risk of axillary disease even after a negative SLN biopsy result. A Bayesian nomogram was designed to combine the probability of axillary disease prior to nodal biopsy with customized test characteristics for an SLN biopsy and provides the probability of axillary disease despite a negative SLN biopsy. Users may individualize the sensitivity of an SLN biopsy based on factors known to modify the sensitivity of the procedure. This tool may be useful in identifying patients who should have expanded upfront exploration of the axilla or comprehensive axillary irradiation.
Highlights
In breast cancer, metastases to the axilla are associated with an increased risk of distant micrometastatic disease [1,2,3]
We developed a nomogram that combines this probability of axillary disease with estimates of the sensitivity of Sentinel lymph node (SLN) biopsy, to calculate the risk of residual axillary disease despite a negative SLN biopsy
The pretest probability is the probability of having axillary disease prior to any nodal evaluation; the posttest probability is the probability of axillary disease given a negative SLN biopsy; the false-negative rate (1-sensitivity) of SLN biopsy can be estimated from Table 1
Summary
Metastases to the axilla are associated with an increased risk of distant micrometastatic disease [1,2,3]. Sentinel lymph node (SLN) biopsy has become standard practice for evaluating the axilla in patients without palpable lymph nodes [4]. This procedure involves injection of a tracer, usually a radioactive colloid, alone or in combination with dye, into the tissue surrounding a tumor. The SLN procedure typically yields 1–5 nodes for pathologic examination whereas full axillary lymph node dissection (ALND) can yield greater than 20 nodes when taken to completion. A recent randomized trial showed that ALND offered no benefit over SNL biopsy in terms of local control or survival to women with early clinical stage breast cancer who received radiation therapy [6]
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