Non-sentinel Node Metastasis Research Articles

Intraoperative prediction of the two axillary lymph node macrometastases threshold in patients with breast cancer using a one-step nucleic acid cytokeratin-19 amplification assay.

The aim of the present study was to assess the sensitivity, specificity and practicality of using a one-step nucleic acid amplification (OSNA) assay during breast cancer staging surgery to predict and discriminate between at least 2 involved nodes and more than 2 involved nodes and facilitate the decision to provide axillary conservation in the presence of a low total axillary node tumour burden. A total of 700 consecutive patients, not treated with neo-adjuvant chemotherapy, received intraoperative sentinel lymph node (SLN) analysis using OSNA for cT1-T3 cN0 invasive breast cancer. Patients with at least one macrometastasis on whole-node SLN analysis underwent axillary lymph node dissection (ALND). The total tumour load (TTL) of the macrometastatic SLN sample was compared with the non-sentinel lymph node (NSLN) status of the ALND specimen using routine histological assessment. In total, 122/683 patients (17.9%) were found to have an OSNA TTL indicative of macrometastasis. In addition, 45/122 (37%) patients had NSLN metastases on ALND with a total positive lymph node burden exceeding the American College of Surgeons Oncology Group Z0011 trial threshold of two macrometastatic nodes. The TTL negative predictive value was 0.975 [95% confidence interval (CI), 0.962–0.988]. The area under the curve for the receiver operating characteristic curve was 0.86 (95% CI, 0.81–0.91), indicating that SLN TTL was associated with the prediction (and partitioning) of total axillary disease burden. OSNA identifies a TTL threshold value where, in the presence of involved SLNs, ALND may be avoided. This technique offers objective confidence in adopting conservative management of the axilla in patients with SLN macrometastases.

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.

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

BackgroundSentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear.MethodsIn an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis.ResultsImmediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group.ConclusionsImmediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895.)

Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study.

Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma. Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population. The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5-50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4years (95% CI 0.75-2.0) for patients with a positive SLNB, and5.9years (95% CI 1.7-10.2)in SLNB-negative patients (p=0.18). There was a trend towards improved overall survival for patients with a negative SLNB (p=0.06). SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.

Prediction of Non-Sentinel Lymph Node Metastasis by Molecular Assay in Whole Sentinel Lymph Node Analysis in Breast Cancer Patients

Objective: To determine whether the total tumor load (TTL) as indicated through the one-step nucleic acid amplification(OSNA) assay can be a predictive factor of non-sentinel lymph node (SLN) metastasis in early breast cancer patients.Material and Method: The records of 102 patients with cT1-3N0 breast cancer who had an intraoperative SLN evaluationperformed through an OSNA assay at Songklanagarind Hospital between 1 January 2015 and 30 May 2016 were examined.Results: Univariate analysis found TTL, tumor size, presence of lymphovascular invasion, and macrometastasis weresignificant predictive factors of non-SLN metastasis. In the multivariate analysis, TTL was the only predictive factor withstatistical significance (OR 1.1, 95% CI=1.0, 1.2). The area under the receiver operating characteristics (ROC) curve ofTTL was 0.9 (95% CI=0.8, 0.9).Conclusion: TTL is a significant predictive factor of non-SLN metastasis in early breast cancer patients.

P054 - Metastasis in non-sentinel lymph node correlates with ALDH-1 expression in sentinel lymph node

P054 - Metastasis in non-sentinel lymph node correlates with ALDH-1 expression in sentinel lymph node

P300 - Construction of a nomogram, based on one-step nucleic acid amplification, for prediction of non-sentinel node metastasis in breast cancer patients with sentinel node metastasis

P300 - Construction of a nomogram, based on one-step nucleic acid amplification, for prediction of non-sentinel node metastasis in breast cancer patients with sentinel node metastasis

Abstract P2-01-16: Comparison of axillary nodal status between different defined clinically node negative breast cancer: Is ACOSOG Z0011 criteria applicable to preoperative cytologically negative axilla?

Abstract Background Axillary ultrasound (AUS) and US-guided fine-needle aspiration (FNA) are now part of the preoperative axillary assessment. The ACOSOG Z0011 trial demonstrated axillary lymph node dissection (ALND) may be omitted in patients with T1-2 tumor, clinically negative axilla and 1-2 positive sentinel lymph nodes (SLN). But for clinically node negative patients with AUS suspicious but FNA negative axilla, whether they could receive the same surgical procedure and omit ALND referencing to Z0011 criteria as clinically node negative patients identified by AUS has not been illustrated. The purpose of this study was to evaluate potential differences in axillary lymph node (ALN) metastatic status between clinically node negative patients identified by AUS (AUS group) and FNA (FNA group). Methods Patients with T1-2 tumor and clinically negative axilla treated in Shanghai Ruijin Hospital from Jan 2013 to Dec 2015 were enrolled. ALN metastatic status were compared between AUS group and FNA group. Results A total of 1007 patients were included. Preoperative axillary status (AUS negative or FNA negative) did not differ significantly between ALN positive and ALN negative patients (p = 0.170). Similarly, ALN metastatic status (negative, 1-2 positive or ≥3 positive) did not differ significantly between AUS group and FNA group (p = 0.405) table 1. ALN status of patients with different defined clinically node negative breast cancer AUS group N = 886 (%)FNA group N = 121 (%)P valueALN status 0.405Negative740 (83.5)95 (78.5) 1-2 positive125 (14.1)125 (14.1) ≥3 positive21 (2.4)4 (3.3) Subset analysis of patients fulfilling Z0011 eligibility criteria showed no significant difference in nonsentinel lymph node (NSLN) metastasis rate (p = 0.591) and number of positive lymph nodes (p = 0.777) between AUS group and FNA group. table 2. Nodal status of 1-2 SLN positive patients with different defined clinically node negative breast cancer AUS group N = 138 (%)FNA group N = 24 (%)P valueNSLN 0.591Positive27 (19.6)3 (12.5) Negative111 (80.4)21 (87.5) Number of positive lymph nodes 0.777194 (68.1)13 (9.4) 231 (22.5)4 (16.7) 3 or more13 (9.4)2 (8.3) Conclusions Patients with clinically node negative axilla identified by FNA were comparable to those identified by AUS in ALN metastatic status. Indicating that patients with preoperative FNA negative axilla could receive the same surgical procedure and may omit ALND referencing to Z0011 criteria as preoperative AUS negative patients. Citation Format: Liang Y, Chen X, Zhu Y, Wu J, Huang O, Zong Y, Zhu S, Gao W, He J, Zhu L, Chen W, Li Y, Shen K. Comparison of axillary nodal status between different defined clinically node negative breast cancer: Is ACOSOG Z0011 criteria applicable to preoperative cytologically negative axilla? [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 P2-01-16.

Predicting Sentinel and Non-sentinel Lymph Node Metastasis – are MSKCC Nomograms Valid for Non-screened Breast Cancer Patients?

Predicting Sentinel and Non-sentinel Lymph Node Metastasis – are MSKCC Nomograms Valid for Non-screened Breast Cancer Patients?

The Pre-Treatment Neutrophil-Lymphocyte Ratio: a Useful Tool in Predicting Non-Sentinel Lymph Node Metastasis in Breast Cancer Cases

Background:The sentinel lymph node (SLN) biopsy is a highly accurate predictor of overall axillary nodal status in early breast cancer patients. There is however, still a debate on which patients with a positive SLN can benefit from axillary lymph node dissection (ALND). Numerous studies have been designed to identify variables that are predictive of non-SLN metastasis to avoid a complete ALND. The aim of this study was to determine whether the pre-treatment neutrophil-lymphocyte ratio (NLR) can be a predictive factor of non-SLN metastasis in early breast cancer patients.Materials and Methods:The records of 214 consecutive patients with cT1-3N0 invasive breast cancer who had undergone intraoperative SLN evaluation at Songklanagarind Hospital between the 1st of March 2011 and the 30th of May 2016 were examined. Data on patient demographics, tumor variables and NLR were collected and factors for non-SLN metastasis were analyzed using multivariate logistic regression. The power of the NLR was quantified with receiver operating characteristics (ROC) curves as measured by the areas under curves (AUC).Results:Multivariate analysis established presence of lymphovascular invasion (OR 8.4, 95%CI 2.3-31.3, p=0.002), macrometastasis (OR 6.6, 95%CI 1.8-24.7, p=0.005), and NLR (OR 2.3, 95%CI 1.1-4.8, p=0.033) as predictive factors of non-SLN metastasis with statistical significance. The AUC for NLR was 0.7 (95%CI 0.6-0.8) with an optimal cut-off of 2.6 giving a sensitivity of 62%, a specificity of 83.8%, a positive predictive value of 77.3% and a negative predictive value of 70.5%.Conclusion:Pre-treatment NLR is a useful diagnostic aid for predicting additional non-SLN metastasis.

Total tumor load assessed by one-step nucleic acid amplification assay as an intraoperative predictor for non-sentinel lymph node metastasis in breast cancer

BackgroundThis study aimed to determine the relationship between CK19 mRNA copy number in sentinel lymph nodes (SLN) assessed by one-step nucleic acid amplification (OSNA) technique, and non-sentinel lymph nodes (NSLN) metastization in invasive breast cancer. A model using total tumor load (TTL) obtained by OSNA technique was also constructed to evaluate its predictability. MethodsWe conducted an observational retrospective study including 598 patients with clinically T1-T3 and node negative invasive breast cancer. Of the 88 patients with positive SLN, 58 patients fulfill the inclusion criteria. ResultsIn the analyzed group 25.86% had at least one positive NSLN in axillary lymph node dissection. Univariate analysis showed that tumor size, TTL and number of SLN macrometastases were predictive factors for NSLN metastases. In multivariate analysis just the TTL was predictive for positive NSLN (OR 2.67; 95% CI 1.06–6.70; P = 0.036). The ROC curve for the model using TTL alone was obtained and an AUC of 0.805 (95% CI 0.69–0.92) was achieved. For TTL >1.9 × 105 copies/μL we got 73.3% sensitivity, 74.4% specificity and 88.9% negative predictive value to predict NSLN metastases. ConclusionWhen using OSNA technique to evaluate SLN, NSLN metastases can be predicted intraoperatively. This prediction tool could help in decision for axillary lymph node dissection.

300P - Predictive factors for nonsentinel lymph node metastasis in patients with positive sentinel lymph nodes after neoadjuvant chemotherapy

Axillary lymph node (ALN) status is an important prognostic factor for breast cancer patients. With increasing numbers of patients undergoing neoadjuvant chemotherapy (NAC), issues concerning sentinel lymph node biopsy (SLNB) after NAC have emerged. We analyzed clinicopathological features and developed a nomogram to predict the possibility of nonsentinel lymph node (NSLN) metastases in patients with positive SLNs after NAC. A retrospective chart review was performed for 141 patients who were clinically ALN positive at presentation, had a positive SLN after NAC on subsequent SLNB, and underwent axillary lymph node dissection (ALND) between 2008 and 2014. On univariate analysis, SLN metastasis size, clinical ALN status after NAC, lymphovascular invasion (LVI), number of positive SLNs, number of negative SLNs, and pathologic T stage were significantly associated with likelihood of NSLN metastases (P < 0.05). On multivariate stepwise logistic regression analysis, pathologic T stage, SLN metastasis size, LVI, and number of positive SLN metastases were independent predictors for NSLN metastases (P < 0.05). The NAC nomogram was based on these four variables. A receiver operating characteristic curve was plotted and the area under the curve (AUC) was 0.791 for the NAC nomogram. In internal validation of performance, the AUC was 0.801 and 0.760. The nomogram was validated in an external patient cohort with AUC of 0.705. The NAC nomogram was developed to predict the likelihood of additional positive NSLNs because this information may help dictate appropriate axillary surgery in the future as we strive to safely minimize axillary morbidity.

Prediction of nonsentinel lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes

The aim of the present study was to investigate the association between non sentinel lymph node metastasis (NSLNM) and clinicopathological factors, particularly in the case of sentinel lymph node (SLN) metastasis in one or two, in clinically node negative patients with breast cancer. Between 10/2010 and 10/2014, 350 sentinel lymph node biopsy (SLNB) were performed in patients with histologically proven primary breast cancer in our clinic. The data collection includes the following characteristics: age, pathological tumor size, histological type, histological grade, lymphovascular invasion (LVI), number of positive SLN, size of the SLN metastasis (macrometastasis, micrometastasis, isolated tumor cells), multifocality (MF), extracapsuler invasion (ECI) of the SLN, the estrogen receptor (ER) status, the progesterone receptor (PR) status and the Her 2 receptor status, Ki 67 reseptor status. Data were collected retrospectively and then analyzed. A successful SLN biopsy were performed in 345 (98.5%) cases. SLN metastases were detected in 110 (31.8%) cases. These patients then underwent axillary dissection; among these patients, 101 (91.8%) had only one to two positive SLNs. Of the 101 patients with positive SLN biopsies, 32 (31.6%) had metastases in the NSLNs. Univariate and multivariate analysis showed that lymphovascular invasion, extracapsular invasion (ECI), Her-2 receptor positive, and Ki-67 > 14% were related to NSLNM (p<.0.05). The predicting factors of NSLNM were LVI, ECI, Ki-67 level, Her-2 reseptor positive and but should be further validated in our institutions, different institutions and different patient groups prospectively.

Additional non-sentinel lymph node metastases in early oral cancer patients with positive sentinel lymph nodes

To determine risk factors for additional non-sentinel lymph node metastases in neck dissection specimens of patients with early stage oral cancer and a positive sentinel lymph node biopsy (SLNB). A retrospective analysis of 36 previously untreated SLNB positive patients in our institution and investigation of currently available literature of positive SLNB patients in early stage oral cancer was done. Degree of metastatic involvement [classified as isolated tumor cells (ITC), micro- and macrometastasis] of the sentinel lymph node (SLN), the status of other SLNs, and additional non-SLN metastases in neck dissection specimens were analyzed. Of 27 studies, comprising 511 patients with positive SLNs, the pooled prevalence of non-SLN metastasis in patients with positive SLNs was 31 %. Non-SLN metastases were detected (available from 9 studies) in 13, 20, and 40 % of patients with ITC, micro-, and macrometastasis in the SLN, respectively. The probability of non-SLN metastasis seems to be higher in the case of more than one positive SLN (29 vs. 24 %), the absence of negative SLNs (40 vs. 19 %), and a positive SLN ratio of more than 50 % (38 vs. 19 %). Additional non-SLN metastases were found in 31 % of neck dissections following positive SLNB. The presence of multiple positive SLNs, the absence of negative SLNs, and a positive SLN ratio of more than 50 % may be predictive factors for non-SLN metastases. Classification of SLNs into ITC, micro-, and macrometastasis in the future SLNB studies is important to answer the question if treatment of the neck is always needed after positive SLNB.

CK19 mRNA in blood can predict non-sentinel lymph node metastasis in breast cancer.

Reverse-transcription polymerase chain reaction (RT-PCR) is used to detect CK19 mRNA in sentinel lymph node biopsy (SLNB) tissues from breast cancer patients. We examined whether CK19 mRNA in peripheral blood is predictive of non-sentinel lymph node (nSLN) metastasis. Breast cancer cases diagnosed with clinical stage cT1–3cN0 and registered in our medical biobank were identified retrospectively. This study then included 120 breast cancer cases treated at Zhejiang Cancer Hospital from Aug 2014 to Aug 2015, including 60 SLN-positive and 60 SLN-negative cases. CK19 mRNA levels in peripheral blood samples were assessed using RT-PCR prior to tumor removal. During surgery, if SLNB tissue showed evidence of metastasis, axillary lymph node dissection (ALND) was performed. No ALND was performed if SLNB and nSLN tissues were both negative for metastasis. CK19 expression was higher in nSLN-positive patients than in nSLN-negative patients (p < 0.05). Logistic regression indicated that lymphatic vessel invasion and CK19 levels were predictive of nSLN status (p < 0.05). The area under the ROC curve for CK19 was 0.878 (p < 0.05). We conclude that high CK19 levels in peripheral blood may independently predict nSLN metastasis in breast cancer patients.

OSNA copy number as a predictor of significant non-sentinel lymph node metastases

OSNA copy number as a predictor of significant non-sentinel lymph node metastases

Predictive factors for non-sentinel node metastases in breast cancer: Preliminary results of a risk model

Predictive factors for non-sentinel node metastases in breast cancer: Preliminary results of a risk model

POU5F1/Oct-4 expression in breast cancer tissue is significantly associated with non-sentinel lymph node metastasis.

BackgroundAt present, few studies have explored the significance of POU5F1 (also known as octamer-bingding factor, Oct-4 or Oct-3) expression in breast cancer tissues.MethodsA total of 121 patients were retrospectively selected between May 2010 and March 2013 to investigate the relationship between POU5F1/Oct-4 expression in breast cancer tissues and non-sentinel lymph node (non-SLN) metastases and to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram. All patients had early-stage breast cancer, which was histologically confirmed by the Department of Surgical Oncology, The First Affiliated Hospital of China Medical University. Histological type and grade of tumors were determined from tissue samples by hematoxylin and eosin staining, while the presence of POU5F1/Oct-4 protein was determined by immunohistochemistry. POU5F1/Oct-4 expression levels in tissues obtained from patients with sentinel lymph node (SLN) and non-SLN metastasis and in tissues obtained from patients without lymph node metastases were compared.ResultsPOU5F1/Oct-4 expression levels in breast cancer tissues were significantly higher in both the SLN metastasis and non-SLN metastasis groups (P = 0.003 and P = 0.030, respectively). Furthermore, POU5F1/Oct-4 expression was found to be associated to both histological (P = 0.01) and molecular type (P = 0.03). Thus, our data once again confirms the validity of the MSKCC nomogram. The area under curve (AUC) was 0.919 (95 % CI: 0.869–0.969, P < 0.001). The probability of non-SLN metastasis generated from the MSKCC nomgram was significantly higher in the POU5F1/Oct-4 positive group than in the POU5F1/Oct-4 negative group. Both univariate and multivariate analysis revealed that Oct-4 expression levels were significantly associated with non-SLN metastases (P = 0.030 and P = 0.034, respectively).ConclusionsPOU5F1/Oct-4 expression levels are significantly associated with non-SLN metastases. Patients with higher probabilities of metastasis generated from the MSKCC nomogram may also have higher POU5F1/Oct-4 expression levels.

Abstract P3-01-13: Risk factors of non-sentinel lymph node metastasis in breast cancer patients with metastatic sentinel lymph node

Abstract Objective To study the factors influencing the non-sentinel lymph node(NSLN) status and to assess Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram performance in predicting SLN metastases in a sentinel lymph node(SLN) positive Chinese breast cancer population. Methods Data were collected from breast cancer patients who were diagnosed with pathological positive sentinel lymph node and received further axillary lymph node dissection(ALND) in Shanghai Ruijin Hospital from January 2011 to August 2014. Use MSKCC nomogram to calculate each patient's NSLN metastasis risk score. The receiver operator characteristic curve(ROC curve)and the area under the ROC curve(AUC)was used to assess the predictive accuracy of the model. Results Among the 1147 patients who received sentinel biopsy in our center, 150 SLN positive patients who received ALND were enrolled in this study. By univariate analysis, multifocal breast cancer (P = 0.017), SLN+/SLN ratio (P = 0.010) and axillary lymphadenopathy displayed by ultrasound(P = 0.005) are the influencing factors of NSLN metastases. By multivariate analysis, multifocal breast cancer (OR 7.25, 95% CI 1.73∼30.43, P = 0.007), SLN+/SLN ratio≥0.5 (OR 2.564, 95% CI 1.22∼5.39, P = 0.013) and axillary lymphadenopathy displayed by ultrasound (OR 2.471, 95% CI 1.18∼5.19, P = 0.017) are the independent influencing factors of NSLN metastases. The AUC of MSKCC nomogram in this population is 0.677. Conclusion For breast cancer patients with positive sentinel lymph node, multifocality, SLN+/SLN ratio and axillary lymphadenopathy displayed by ultrasound is related to NSLN metastasis. MSKCC has low accuracy in predicting NSLN status of this population. Citation Format: Huang J, Chen X, Shen K, Li Y, Chen W, He J, Zhu L, Huang O, Zong Y, Fei X, Jin X. Risk factors of non-sentinel lymph node metastasis in breast cancer patients with metastatic sentinel lymph node. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-13.

Abstract P3-01-14: A nomogram to predict the likelihood of axillary non-sentinel lymph node metastases in sentinel lymph node positive primary breast cancer patients

Abstract Background: Completion of axillary lymph node dissection (ALND) was long lasting standard in patients with non-metastatic primary breast cancer (PBC) and axillary sentinel lymph node (SLN) involvement. However, this approach is currently questioned since recent prospective trials have found that some SLN-positive women with PBC might not benefit from subsequent ALND. Nomograms that estimate the probability of further non-sentinel lymph node (NSLN) metastases could guide clinical decisions. Methods: We compared the predictability of three different nomograms (MSKCC, Stanford University, Cambridge) on the NSLN status with an own logistic regression model in a training and validation set. SLN-positive women who underwent primary surgery including ALND at Tuebingen University, Germany, between 06/2005 - 12/2009 (training set) and 01/2010 - 02/2012 (validation set) were available for this analysis. The area under the receiver operating characteristics (ROC) curve was calculated for each nomogram. Results: 295 and 175 patients were included into the training and validation set, respectively. Of these 118 (40%) and 57 (33%) patients were NSLN-positive. Variables within our model were tumor size, proportion of positive SLNs, size of SLN metastases, lymphangiosis carcinomatosa, multicentricity and extracapsular invasion. The respective area under the ROC curve values for the MSKCC / Stanford University / Cambridge / own regression model were 0.73 / 0.70 / 0.63 / 0.75 in the training set and 0.73 / 0.66 / 0.52 / 0.73 in the validation set. Conclusion: The predictability of our logistic regression model was comparable to the MSKCC nomogram and superior to the Stanford University and Cambridge nomogram. Although a training and a validation set was used, further testing on an independent patient population is warranted. Citation Format: Hartkopf AD, Brucker SY, Helms G, Henzel M, Hahn M, Wallwiener M, Schoenfisch B, Taran F-A, Fehm TN. A nomogram to predict the likelihood of axillary non-sentinel lymph node metastases in sentinel lymph node positive primary breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-14.