A simple scoring system to determine axillary lymph node metastasis in carcinoma breast
DOI:
https://doi.org/10.18203/2349-2902.isj20193337Keywords:
Axillary lymph node metastasis, Carcinoma breast, Sentinel lymph node biopsyAbstract
Background: The aim of this study is to develop a scoring system wherein axillary lymph node metastasis in carcinoma breast can be predicted preoperatively using simple variables.
Methods: A prospective study carried out from December 2017-November 2018 at Rajarajeswari Medical College and Hospital. All clinically node negative cases were included. Data from clinical examination, histopathology report and immunohistochemistry (obtained from trucut biopsy preoperatively) is correlated with presence or absence of lymph node metastasis obtained after modified radical mastectomy. And a scoring system is proposed according to the results obtained.
Results: Out of 36 cases studied, 12 cases had score <10, 11 cases had score 11-13, 13 cases had score >14, indicating that more than 50% of cases were over treated with axillary lymph node dissection.
Conclusions: Lymph node metastasis in carcinoma breast can be predicted clinically using a scoring system. Further a recommendation for or against axillary node dissection can be made according to the respective scores.
References
Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569-75.
Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph node resection compared with conventional axillary-lymph- node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927-33.
Morrow M. Sentinel Lymph Node Biopsy: Benefits and Limitations. Zentralbl Gynakol. 2003;125(9):335-7.
Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546-53.
Yoo SH, Park IA, Chung YR, Kim H, Lee K, Noh DY et al. A histomorphologic predictive model for axillary lymph node metastasis in preoperative breast cancer core needle biopsy according to intrinsic subtypes. Hum Pathol. 2015;46(2):246-54.
Lyman GH, Giuliano AE, Somerfield MR, Benson AB III, Bodurka DC, et al. American Society of Clinical Oncology. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-20.
Smeets A, Ryckx A, Belmans A,Wildiers H, Neven P, Floris G, et al. Impact of tumor chronology and tumor biology on lymph node metastasis in breast cancer. Springerplus. 2013;2(1):480.
Cianfrocca M, Goldstein LJ. Prognostic and predictive factors in early-stage breast cancer. Oncologist. 2004;9(6):606-16.
Meretoja TJ, Heikkilä PS, Mansfield AS, Cserni G, Ambrozay E, Boross G, et al. A predictive tool to estimate the risk of axillary metastases in breast cancer patients with negative axillary ultrasound. Ann Surg Oncol. 2014;21(7):2229-36.
Denley H, Pinder SE, Elston CW, Lee AH, Ellis IO. Preoperative assessment of prognostic factors in breast cancer. J Clin Pathol. 2001;54(1):20-4.
Giuliano AE, Ballman K, McCall L, Beitsch P, Whitworth PW, Blumencranz P et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264(3):413-20.
Dengel LT, Van Zee KJ, King TA, Stempel M, Cody HS, El-Tamer M et al. Axillary dissection can be avoided in the majority of clinically node- negative patients undergoing breast-conserving therapy. Ann Surg Oncol. 2014;21(1);22-7.
Dihge L, Bendahl PO, Rydén L: Nomograms for preoperative prediction of axillary nodal status in breast cancer. Br J Surg. 2017;104(11):1494-505.
Takada M, Sugimoto M, Naito Y, Moon HG, Han W, Noh DY, et al. Prediction of axillary lymph node metastasis in primary breast cancer patients using a decision tree-based model. BMC Medical Informatics and Decision Making. 2012;12(1):54.
