Non-sentinel Node Involvement Research Articles

Prediction of Non-sentinel Node Status in Patients with Melanoma and Positive Sentinel Node Biopsy: An Italian Melanoma Intergroup (IMI) Study.

Approximately 20% of melanoma patients harbor metastases in non-sentinel nodes (NSNs) after a positive sentinel node biopsy (SNB), and recent evidence questions the therapeutic benefit of completion lymph node dissection (CLND). We built a nomogram for prediction of NSN status in melanoma patients with positive SNB. Data on anthropometric and clinicopathological features of patients with cutaneous melanoma who underwent CLND after a positive SNB were collected from nine Italian centers. Multivariate logistic regression was utilized to identify predictors of NSN status in a training set, while model efficiency was validated in a validation set. Data were available for 1220 patients treated from 2000 through 2016. In the training set (n=810), the risk of NSN involvement was higher when (1) the primary melanoma is thicker or (2) sited in the trunk/head and neck; (3) fewer nodes are excised and (4) more nodes are involved; and (5) the lymph node metastasis is larger or (6) is deeply located. The model showed high discrimination (area under the receiver operating characteristic curve 0.74, 95% confidence interval [CI] 0.70-0.79) and calibration (Brier score 0.16, 95% CI 0.15-0.17) performance in the validation set (n=410). The nomogram including these six clinicopathological variables performed significantly better than five other previously published models in terms of both discrimination and calibration. Our nomogram could be useful for follow-up personalization in clinical practice, and for patient risk stratification while conducting clinical trials or analyzing their results.

A prediction tool incorporating the biomarker S-100B for patient selection for completion lymph node dissection in stage III melanoma

IntroductionCompletion lymph node dissection (CLND) in sentinel node (SN)-positive melanoma patients is accompanied with morbidity, while about 80% yield no additional metastases in non-sentinel nodes (NSNs). A prediction tool for NSN involvement could be of assistance in patient selection for CLND. This study investigated which parameters predict NSN-positivity, and whether the biomarker S-100B improves the accuracy of a prediction model. MethodsRecorded clinicopathologic factors were tested for their association with NSN-positivity in 110 SN-positive patients who underwent CLND. A prediction model was developed with multivariable logistic regression, incorporating all predictive factors. Five models were compared for their predictive power by calculating the Area Under the Curve (AUC). A weighted risk score, ‘S-100B Non-Sentinel Node Risk Score’ (SN-SNORS), was derived for the model with the highest AUC. Besides, a nomogram was developed as visual representation. ResultsNSN-positivity was present in 24 (21.8%) patients. Sex, ulceration, number of harvested SNs, number of positive SNs, and S-100B value were independently associated with NSN-positivity. The AUC for the model including all these factors was 0.78 (95%CI 0.69–0.88). SN-SNORS was the sum of scores for the five parameters. Scores of ≤9.5, 10–11.5, and ≥12 were associated with low (0%), intermediate (21.0%) and high (43.2%) risk of NSN involvement. ConclusionsA prediction tool based on five parameters, including the biomarker S-100B, showed accurate risk stratification for NSN-involvement in SN-positive melanoma patients. If validated in future studies, this tool could help to identify patients with low risk for NSN-involvement.

CK19 combined with contrast-enhanced ultrasound: A prediction model for non-sentinel lymph node involvement in early breast cancer.

11539 Background: According to Z0011 and AMAROS trials, patients with breast cancer stage cT1~2cN0 and sentinel lymphnode (SLN) 1~2 involvement can avoid axillary lymphnode dissection (ALND). But the risk of non-sentinel lymphnode (nSLN) involvement in those early stage patients is still unclear and it is difficult to predicting the risk before surgery. Our previous study showed CK19 mRNA in peripheral blood had predicative value of nSLN involvement. Also, contrast-enhanced ultrasound (CEUS) is a new effective method exmaming axillary lymph node. We aim to establish a prediction model for nSLN involvement in early breast cancer using CK19 combined with CEUS score. Methods: We identified 119 cases diagnosed early breast cancer (stage cT1~2cN0 and 1~2 SLNs involvement as in Z0011 and AMAROS trials) from Oct 2015 to Nov 2016 in Zhejiang Cancer Hospital. The CK19 mRNA of peripheral blood by RT-PCR and CEUS score of axillary lymph nodes were acquired before surgery. We used logistic regression analysis for filtering out valuable predictive clinical parameters and establishing formulas to calculate the probability of nSLN involvement. Our model was compared with Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, which is one of the most reliable and validated methods for predicting of nSLN. Results: The histological grade, CK19 and CEUS score were screened by logistic regression analysis into the formula to calculate the probability of nSLN involvement. The sensitivity, specificity, total accuracy of this model was 89.13%, 80.82% and 84.03%, respectively. The false negative rate was 10.87%. The model had high quality of consistency (Kappa 0.675, p < 0.01) and goodness of fit (likelihood-ratio test, -2log liklihood = 84.607). The area under curve (AUC) of ROC was significantly higher (P < 0.01) in our model (0.914, 95%CI, 0.863~0.965) than in MSKCC nomogram (0.563, 95%CI, 0.459~0.667). Conclusions: The prediction model based on CK19 and CEUS score has satisfying sensitivity, specificity and accuracy, more effective than MSKCC nomogram. It is a valuable model of evaluating the risk of nSLN involvement in early breast cancer before surgery, picking out the patients who can truly avoid ALND.

Abstract P2-01-33: Non-sentinel lymph nodes involvement in early breast cancer patients: Performance of two predictive nomograms integrating the analysis of sentinel nodes by one step nucleic acid amplification in a cohort of 299 patients

Abstract Backgrounds: Sentinel lymph node (SLN) biopsy is a highly accurate predictor of axillary status and has become the surgical axillary standard in breast cancer patients. About 50–70 % of patients with involved SLN have no additional non sentinel node (NSN) involved, suggesting that it be possible to avoid ALND in selected patients. Many tools have been developed to help surgeons in NSLN evaluation but they all need pathological data from tumor and SLN and can't be used during surgery. Developed for intraoperative detection of SLN macro or micrometastasis involvement, the semi-automated molecular one step nucleic acid amplification (OSNA), as accurate as pathology, is available. Two simple nomograms have been developed to predict NSN involvement based on the number of CK19 mRNA copy determined by OSNA: · Nomogram developed by Peg V (Eur J Surg Oncol 2013): based on total tumoral load (TTL). TTL is defined as the addition of CK19 mRNA copies of each positive SLN (copies/μL). A TTL≥1.2 × 10(5) copies/ml (specificity=85.3%, negative predictive value (NPV) = 80%) can predict NSN involvement. · Nomogram developed by Di Filippo F (Journal of Experimental & Clinical Cancer Research 2015): based on the number of CK19 mRNA copies and ultrasound tumor size. These two variables are categorized using quartiles with a score for each and the addition of both corresponds to a probability of NSN involvement (sensitivity = 98.1%, NPV = 92.5 %). Patients and Methods: this is a retrospective study of 299 patients. Each patient had SLN involvement (macro or micrometastasis) and underwent a complementary ALND. The main objective was to evaluate the performance of each nomogram using a discrimination ability model, assessed by ROC analysis. Predictive accuracy was measured by the area under ROC curves (AUC) reported with its 95 % confidence interval. The second objective was to compare the two nomograms using Hanley & McNeil method, to test the statistical significance of the difference between the AUC. Analysis was performed using stata 13.1 SE. Results: The mean age was 59, 1 year. Most patients were treated for an infiltrating ductal carcinoma (80.3%, 240/299). The mean ultrasound tumor size was 13 mm and the mean pathological tumor size was 15 mm. The median number of examined SLN was 2 with a macro-metastasis in 67, 6%, 202/299). 70 patients had involved nodes in ALND (23%). The discrimination of N Peg, quantified with AUC was 0.685 (p<0, 00001). The discrimination of N Di Filippo, quantified with AUC was 0.72 (p<0, 00001). Hanley & McNeil method shows that Di Filippo nomogram is significantly superior to Peg nomogram (p=0,048). Conclusion: The current study shows that these two nomograms are reliable and can be used to predict NSLN involvement. The combination of molecular data and ultrasound tumor size seems to be more efficient than molecular data alone. These results are similar to results of nomogram studies based on pathological analysis but only these nomograms integrating molecular data can be used during the surgery. Citation Format: Bordes V, Campion L, Jezequel P, Lefrancois A, Boiffard F, Brillaud-Meflah V, Dravet F, Jaffre I, Classe J-M. Non-sentinel lymph nodes involvement in early breast cancer patients: Performance of two predictive nomograms integrating the analysis of sentinel nodes by one step nucleic acid amplification in a cohort of 299 patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-33.

Elaboration of a nomogram to predict nonsentinel node status in breast cancer patients with positive sentinel node, intraoperatively assessed with one step nucleic amplification: Retrospective and validation phase.

BackgroundTumor-positive sentinel lymph node (SLN) biopsy results in a risk of non sentinel node metastases in micro- and macro-metastases ranging from 20 to 50%, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. We have previously developed a mathematical model for predicting patient-specific risk of non sentinel node (NSN) metastases based on 2460 patients. The study reports the results of the validation phase where a total of 1945 patients were enrolled, aimed at identifying a tool that gives the possibility to the surgeon to choose intraoperatively whether to perform or not axillary lymph node dissection (ALND).MethodsThe following parameters were recorded: Clinical: hospital, age, medical record number; Bio pathological: Tumor (T) size stratified in quartiles, grading (G), histologic type, lymphatic/vascular invasion (LVI), ER-PR status, Ki 67, molecular classification (Luminal A, Luminal B, HER-2 Like, Triple negative); Sentinel and non-sentinel node related: Number of NSNs removed, number of positive NSNs, cytokeratin 19 (CK19) mRNA copy number of positive sentinel nodes stratified in quartiles. A total of 1945 patients were included in the database. All patient data were provided by the authors of this paper.ResultsThe discrimination of the model quantified with the area under the receiver operating characteristics (ROC) curve (AUC), was 0.65 and 0.71 in the validation and retrospective phase, respectively. The calibration determines the distance between predicted outcome and actual outcome. The mean difference between predicted/observed was 2.3 and 6.3% in the retrospective and in the validation phase, respectively. The two values are quite similar and as a result we can conclude that the nomogram effectiveness was validated. Moreover, the ROC curve identified in the risk category of 31% of positive NSNs, the best compromise between false negative and positive rates i.e. when ALND is unnecessary (<31%) or recommended (>31%).ConclusionsThe results of the study confirm that OSNA nomogram may help surgeons make an intraoperative decision on whether to perform ALND or not in case of positive sentinel nodes, and the patient to accept this decision based on a reliable estimation on the true percentage of NSN involvement. The use of this nomogram achieves two main gools: 1) the choice of the right treatment during the operation, 2) to avoid for the patient a second surgery procedure.

Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift.

-Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes. -To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes. -Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. -The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin-stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non-sentinel lymph node involvement. This information is important to decide on further axillary treatment.

Can axillary node dissection be safely omitted in the elderly? A retrospective study on axillary management of early breast cancer in older women

IntroductionSentinel lymph node biopsy (SLNB) is a minimally invasive technique to stage the axillary lymph node status. The burden of nodal metastasis is of great concern, as the clinical relevance and therapeutic implications of pN1mi and pN0(i+) in the sentinel lymph node (SLN) remain a matter of debate. Materials and methodsWe examined the pathological features of 901 patients above the age of 65 presenting with clinical T1–T2 N0M0 breast tumours (<3 cm), detecting tumours related to llary non-sentinel node (NSN) metastases when the SLN was minimally involved. ResultsA total of 270 patients underwent complete axillary lymph node dissection (cALND) after their SLNB specimen tested positive for macrometastasis, micrometastasis and isolated tumour cells (ITCs). Seventy-six patients were diagnosed with micrometastatic disease pN1mi (27.5%), whilst ITCs (pN0i+) were detected in seven patients (2.5%). NSNs were found to be involved in two patients (2.6%) with micrometastases at the SLN. No further metastatic disease was detected in NSNs when the SLN contained ITCs. At a median follow-up period of 5.8 years, no axillary recurrence was observed among pN1mi and pN0(i+) patients. Lobular histotype, multicentricity and lymphovascular invasion were found to be associated with NSN involvement. DiscussionThe results from our case series are supported by IBCSG 23-01 level 1 evidence, which demonstrated a local recurrence rate of 1% in ‘minimally involved not-surgical treated axilla’. ConclusionsBased on current evidence, we spare well-informed and consenting patients from further axillary surgery when the SLN is minimally involved in early breast cancer within an agreed protocol, whilst scheduling adjuvant treatment based on the patients' primary tumour characteristics.

Breast cancer histology and non-sentinel lymph node involvement following a positive sentinel lymph node biopsy: A multi-institutional cohort study.

1043Background: Management of the axilla in early breast cancer has shifted towards a more conservative surgical approach. The omission of a completion axillary lymph node dissection (cALND) in the context of a positive sentinel lymph node (SLN) has become common, even though this practice may result in residual non-sentinel positive nodes left behind. Furthermore, the axillary management of both invasive ductal and invasive lobular carcinomas (IDCs and ILCs) has traditionally been the same despite the different pattern of invasion and metastases in ILCs. The objective of this study was to determine if lobular histology is an independent predictor of non-sentinel lymph node (NSLN) involvement following a positive SLN biopsy (SLNB). Methods: A multi-institutional cohort study was completed. Patients with node positive IDC or ILC who were treated with both a SLNB followed by cALND from November 1997 to June 2009 were included. The primary outcome was NSLN involvement, defined as having at least one positive...

Increased Angiogenesis and Lymphangiogenesis in Metastatic Sentinel Lymph Nodes Is Associated With Nonsentinel Lymph Node Involvement and Distant Metastasis in Patients With Melanoma.

Lymph node angio- and lymphangio-genesis have been shown to play an important role in the premetastatic niche of sentinel lymph nodes. In the current study we have investigated the association of angio- and lympangio-genesis related parameters in metastatic sentinel lymph nodes of patients with melanoma with the presence of nonsentinel and distant organ metastasis. Peritumoral and intratumoral relative blood and lymphatic vessel areas (evaluated by Chalkley method), blood and lymphatic microvessel densities, and the rates of blood and lymphatic vessel proliferation were assessed in primary tumors and sentinel lymph node metastasis of 44 patients with melanoma using CD34/Ki-67 and D240/Ki-67 immunohistochemical double staining. Primary melanoma exhibited significantly higher rate of lymphatic proliferation compared with its lymph node metastasis (P < 0.05), while lymph node metastasis showed significantly higher rate of blood vessel proliferation (P < 0.05). Using multivariate logistic regression model, the rate of peritumoral lymphatic proliferation was inversely associated with positive nonsentinel lymph node status (P < 0.05), whereas the rate of intratumoral blood vessel proliferation was associated with distant organ metastasis (P < 0.05). Using multivariate Cox regression analysis, the rate of intratumoral blood vessel proliferation was also inversely associated with overall survival of patients with melanoma (P < 0.05).

Predictive factors of non-sentinel lymph node involvement in breast cancer patients with positive sentinel lymph nodes; a 5‑year single centre experience

Background The aim of our study was to determine the number of sentinel nodes (SN) and non-sentinel nodes (NSN) involved and to identify predictive factors of non-sentinel lymph node involvement in breast cancer patients.

84P Predictive factors for non-sentinel lymph node involvement in patients with breast cancer and 1-2 positive sentinel lymph nodes treated with breast conservation

84P Predictive factors for non-sentinel lymph node involvement in patients with breast cancer and 1-2 positive sentinel lymph nodes treated with breast conservation

Factors Influencing Non-sentinel Node Involvement in Sentinel Node Positive Patients and Validation of MSKCC Nomogram in Indian Breast Cancer Population.

Current guidelines recommend completion axillary lymphnode dissection (ALND) when sentinel lymphnode (SLN) contains metastatic tumor deposit. In consequent ALND sentinel node is the only node involved by tumor in 40-70% of cases. Recent studies demonstrate the oncologic safety of omitting completion ALND in low risk patients. Several nomograms (MSKCC, Stanford, MD Anderson score, Tenon score) had been developed in predicting the likelihood of additional nodes metastatic involvement. We evaluated accuracy of MSKCC nomogram and other clinicopathologic variables associated with additional lymph node metastasis in our patients. A total of 334 patients with primary breast cancer patients underwent SLN biopsy during the period Jan 2007 to June 2014. Clinicopathologic variables were prospectively collected. Completion ALND was done in 64 patients who had tumor deposit in SLN. The discriminatory accuracy of nomogram was analyzed using Area under Receiver operating characteristic curve (ROC). SLN was the only node involved with tumor in 69% (44/64) of our patients. Additional lymph node metastasis was seen in 31% (20/64). On univariate analysis, extracapsular infiltration in sentinel node and multiple sentinel nodes positivity were significantly associated (p<0.05) with additional lymph node metastasis in the axilla. Area under ROC curve for nomogram was 0.58 suggesting poor performance of the nomogram in predicting NSLN involvement. Sentinel nodes are the only nodes to be involved by tumor in 70% of the patients. Our findings indicate that multiple sentinel node positivity and extra-capsular invasion in sentinel node significantly predicted the likelihood of additional nodal metastasis. MSKCC nomogram did not reliably predict the involvement of additional nodal metastasis in our study population.

Evaluation of the Probability of Non-sentinel Lymph Node Metastasis in Breast Cancer Patients with Sentinel Lymph Node Metastasis using Two Different Methods.

The aim of this retrospective clinical study was to evaluate the accuracy and feasibility of two different clinical scales, namely the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Tenon's axillary scoring system, which were developed for predicting the non-sentinel lymph node (NSLN) status in our breast cancer patients. The medical records of patients who were diagnosed with breast cancer between January 2010 and November 2013 were reviewed. Those who underwent sentinel lymph node biopsy (SLNB) for axillary staging were recruited for the study, and patients who were found to have positive SLNB and thus were subsequently subjected to axillary lymph node dissection (ALND) were also included. Patients who had neoadjuvant therapy, who had clinically positive axilla, and who had stage 4 disease were excluded. Patients were divided into two groups. Group 1 included those who had negative NSLNs, whereas Group 2 included those who had positive NSLNs. The following data were collected: age, tumor size, histopathological characteristics of the tumor, presence of lymphovascular invasion, presence of multifocality, number of negative and positive NSLNs, size of metastases, histopathological method used to define metastases, and receptor status of the tumor. The score of each patient was calculated according to the MSKCC nomogram and Tenon's axillary scoring system. Statistical analysis was conducted to investigate the correlation between the scores and the involvement of NSLNs. The medical records of patients who were diagnosed with breast cancer and found to have SLNB for axillary staging was reviewed. Finally, 50 patients who had positive SLNB and thus were subsequently subjected to ALND were included in the study. There were 17 and 33 patients in Groups 1 and 2, respectively. Both the MSKCC nomogram and Tenon's axillary scoring system were demonstrated to be significantly accurate in the prediction of the involvement of NSLNs (p<0.05 for each). Among all the parameters, the only one that was found to be correlated with the risk of NSLN involvement was the presence of lymphovascular invasion. The MSKCC nomogram and Tenon's axillary scoring system both seem to be reliable tools for the assessment of NSLN status in SLNB-positive breast cancer in our breast cancer population. Nevertheless, the omission of ALNB in SLNB-positive breast cancer cannot be yet recommended because of the lack of long-term results of current nomograms and scoring systems.

Breast cancer metastasis burden in sentinel nodes analysed using one-step nucleic acid amplification predicts axillary nodal status

BackgroundIn breast cancer patients undergoing sentinel lymph node biopsy (SLNB) analysis using one-step nucleic acid amplification (OSNA), clarity is required as to the risk factors for non-sentinel lymph node (NSLN) involvement upon axillary lymph node dissection (ALND). This study aims to identify these factors, including categorising by extent of sentinel node positivity: solitary positive node (solitary), multiple nodes with some positive (multiple incomplete positive), or multiple nodes all of which are positive (multiple all positive). MethodsWe conducted a cohort study using prospectively collected data on 856 SLNBs analysed using OSNA, from patients with cT1-3 clinically node-negative invasive breast cancer. ALND was performed for 289 positive SLNBs. ResultsNSLN metastases were identified in 73 (25.3%) ALNDs. Significant factors for NSLN involvement on multivariate analysis were: SLNB macrometastases (cytokeratin-19 mRNA count >5000 copies/μl) (adj.OR = 3.01; 95% CI, 1.61–5.66; p = 0.0006), multiple all positive vs. multiple incomplete positive SLNB (adj.OR = 2.92; 95% CI, 1.38–6.19; p = 0.0050), and undergoing mastectomy (adj.OR = 1.89; 95% CI, 1.00–3.55; p = 0.0486). Amongst multiple incomplete positive SLNBs, an 8.8% NSLN risk was identified when only micrometastases were present. ConclusionExtent of sentinel lymph node positivity measured using OSNA predicts NSLN metastasis risk, aiding decisions surrounding axillary treatment.

P043. Specialist Masters Degree in Oncoplastic Breast Surgery: An update of student engagement and feedback

P043. Specialist Masters Degree in Oncoplastic Breast Surgery: An update of student engagement and feedback

P075. A predicitive model for axillary non-sentinel node involvement by one-step nucleic acid amplification (OSNA) and tumour-related factors in the treatment of breast cancer

P075. A predicitive model for axillary non-sentinel node involvement by one-step nucleic acid amplification (OSNA) and tumour-related factors in the treatment of breast cancer Shramana Banerjee, Timothy Davidson, NormanWilliams, Soha ElSheikh, My-Annh Tran-Dang, Debashish Ghosh, Stephen Davison, Mohammed Keshtgar 1 Royal Free London NHS Foundation Trust, London, UK University College London, London, UK

Abstract P2-01-20: The ratio and size of positive sentinel lymph nodes predicts the involvement of non-sentinel lymph nodes following completion axillary lymph node dissection

Abstract Background: The role of Completion Axillary Lymph Node Dissection (CALND) following positive Sentinel Lymph Node Biopsy (SLNB) is being actively debated. The involvement of our unit in the POSNOC trial (which has a no-treatment arm), has prompted a review of our unit’s CALND results, in order to examine predictors of involvement of non-sentinel lymph nodes (n-SLN), to better inform our patients during recruitment. Methods: We retrospectively analysed our experience of SNLB between July 2008 to 2013. A total of 1152 breast cancer patients underwent SLNB based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 99mTc-nanocolloid and Patent Blue V injected peri-areola. Results: Out of 1152 SLN biopsies performed, 224 were positive for metastatic disease. 203 patients were anaesthetically capable of progressing to CALND. On univariate analysis, involved n-SLN on CALND could not be predicted by age (&amp;lt;50 years; 16/77 vs ≥50 years; 93/125, p=0.272), size of tumour (&amp;lt;50mm; 44/193 and ≥50mm; 4/10, p=0.188), procedure (mastectomy; 24/93, WLE; 24/106, p=0.444), lymphovascular invasion (22/97 vs 26/106, p=0.812), number of positive SLN (≤2; 45/196, &amp;gt;2; 3/7, p=0.213), receptor status; ER (negative; 3/13, positive 45/187, p=0.619), PR (negative; 6/28, positive 41/169, p=0.478), Her2 (negative; 43/175, positive 5/25, p=0.414), triple negative (2/8 vs 46/192, p=0.612). There was a trend toward higher incidence of positive n-SLN with increasing grade (G0-2; 28/139 vs G3; 20/64, p=0.062) and extracapsular spread (14/41 vs 32/149, p=0.073), but these did not reach statistical significance. Positive n-SLN on CALND was however predicted by macrometastases in SLN (macrometastases; 39/141 vs micrometastases; 9/62, p=0.029) and ratio of positive nodes (&amp;lt;0.5; 18/109 vs ≥0.5; 30/94, p=0.008). There were 4/224 recurrences (3 distant metastases and 1 loco-regional), which were not predicted by any of the clinicopathological variables investigated. 3 patients who recurred only had one positive node on SLNB. Conclusion In our series of more than 200 SLNB, a ratio of &amp;gt;0.5 positive SLN yield and presence of macrometastases in positive SLN, were associated with positive n-SLN on CALND. Citation Format: Rajiv V Dave, Muhhamed N Chauhan, Maria Ghaus, Sana Ahmed, Shiv Shapra, Joshua Marriott, Craig Sayers, Zbigniew Kryjak, Deedar Ali. The ratio and size of positive sentinel lymph nodes predicts the involvement of non-sentinel lymph nodes following completion axillary lymph node dissection [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-01-20.

Abstract P2-01-29: Axillary involvement in lobular breast cancer

Abstract Purpose: Since the beginning of the use of the technique of selective sentinel node biopsy (SLNB), multiple models have been proposed to predict both the probability of involvement of the sentinel lymoh node (SLN), and, in case it is positive, the likelihood of non-sentinel lymph node (NSLN) involvement. Some of the factors that increase the likelihood of SN involvement (multifocallity, hormonal receptors, larger size…)are frequently found in invasive lobular carcinoma. Invasive lobular carcinoma (ILC) is the second most common histologic type of invasive mammary carcinoma, comprising 5%– 15% of all invasive breast carcinomas. However, in recent decades an increase in the relative incidence of this variant has been reported in the literature. This has been linked to the employment of hormone replacement therapy, the use of assisted reproduction techniques (IVF) or greater availability of diagnostic tools such as breast ultrasound or MRI that allow their better detection. The aim of this study is to determine the extent of axillary involvement in both SLN and NSLN in patients with ILC Patients and Methods 369 cases of infiltrating carcinoma candidates for SLNB technique between April 2010 and April 2013 were reviewed retrospectively. Patients must have a diagnosis of breast cancer of any histological type, with a screening ultrasound without clinical suspicion of axillary involvement. Cases of intraductal carcinoma that underwent SLNB were excluded and even those that were performed prior to neoadjuvant treatment Data on age, histological type, positivity / negativity of the SLN, implementation or not of axillary lymphadenectomy and outcome of involvement of NSLN were collected. Statistical calculations were performed with SPSS. Results Of the 369 selected patients, 291 (79.9%) had invasive ductal carcinoma (IDC), 55 (15.1%) ILC and 18 other histological types (mucinous, colloid, tubular, papillary or mixed). The median age was 58.6 years. SLN could not be found in 5 patientes. 225 (61.8%) had a negative SLN. In 139 (38.2%) patients, SLN was positive, 64 of these cases showed micrometastasis while 75 presented macrometastasis. Among IDC, 108 (37.1%) of the cases had a positive SLN, 53 (49.1%) of them with macrometastases. Among ILC, 27 (49.1%) of the cases presented positive SLN, in 20 of them (74.1%) with macrometastasis. Differences in both the SLN involvement and the presence of macrometastases observed between IDC and ILC were statistically significant (p&amp;lt; 0.001). In those cases were a lymph node dissection was performed, the probability of finding NSLN affection was 18.8% in the case of IDC compared to 55% in patients with ILC (p&amp;lt; 0.001). Conclusions Axillary lymph node involvement in the case of candidates for SLNB is more frequent and more extensive in patients with ILC than in patients with IDC. Citation Format: Pilar Zamora, Covadonga Marti, Ana Roman, Jose M Oliver, Javier de Santiago, Jose I Sanchez-Mendez. Axillary involvement in lobular breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-01-29.

T-stage and positive sentinel nodes ratio are the useful factors to predict non-sentinel node metastasis in breast cancer patients with macro-metastasis in the sentinel node

IntroductionCurrent guidelines recommend completion axillary lymph node dissection (cALND) in case of a sentinel lymph node (SN) metastasis larger than 2 mm (macrometastasis). However in many patients of those, the non-sentinel lymph nodes (NSN) contain no further metastasis, indicating that axillary lymph node dissection provides no benefit. To identify cases who could have undergone omission of the ALND with confidence, we have retrospectively evaluated the predictive factors of NSN metastasis with positive macrometastasis in the SN. MethodsThis study was based on a retrospective database of 420 patients who underwent sentinel lymph node biopsy (SNB) for breast cancer, of whom 61 patients had SN macrometastasis intra- and postoperatively. We examined predictive factors of NSN involvement in 51 cases of these 61 patients who underwent cALND. All clinical and histological variables were analyzed according to NSN status, by using Mann–Whitney U test, univariate and multivariate logistic regression model. ResultsT stage and the proportion of involved SNs among all identified SNs (SN ratio) were correlated with NSN metastasis. Univariate and multivariate analysis showed that T stage and SN ratio were the independent predictive factor of NSN metastasis. The area under ROC curve for SN ratio was 0.71. The best cut off value of SN ratio was 0.667. Negative predictive value to NSN metastasis in cases with both T2 and more than 0.667 of SN ratio was 85.7%. ConclusionIn patients with invasive breast cancer and macrometastasis of SN, T stage and SN ratio were useful for prediction of NSN metastasis.

Predictive factors for additional non-sentinel lymph node involvement in breast cancer patients with one positive sentinel node.

The aim of this study was to identify a subgroup of breast cancer patients in whom it is possible to avoid axillary lymph node dissection (ALND) when the sentinel lymph node (SLN) is positive. A series of 292 patients treated with breast-conserving surgery or mastectomy underwent ALND after positive SLN detection. To correlate SLN metastasis with the chances of finding additional metastasis in non-SLNs we evaluated the main clinicopathological characteristics. No patients received adjuvant radiotherapy to the axillary region. Fifty-six patients (35.4%) with positive SLNs for macrometastases (n = 158) had additional metastases upon completion ALND compared with 7 patients (5.2%) with micrometastases in the SLN (n = 132). Cases with a higher number of positive axillary lymph nodes tended to have higher pT stage (p = 0.004). In multivariate analysis, pT was confirmed as an independent predictor of non-SLN metastases (OR = 2.40; 95% CI = 1.16-4.99). No patients with micrometastases in SLN and cancer lt;10 mm had additional positive non-SLNs. Our results, in agreement with the major published studies, suggest that ALND can be avoided in selected patients without the need for additional treatment to the axillary region.