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Clinicopathologic Factors Predicting Involvement of Nonsentinel Axillary Nodes in Women With Breast Cancer

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Abstract

Background: It is unclear which breast cancer patients with positive sentinel lymph nodes (SLNs) require a completion axillary lymph node dissection. Our aim was to determine factors that predict involvement of nonsentinel axillary nodes (NSLNs) in patients with positive SLNs.

Methods: We reviewed the records of all patients with invasive breast cancer who underwent SLN biopsy at our institution between 1993 and August 2001. Multivariate analysis was used to identify clinicopathologic features in SLN-positive patients that predict involvement of NSLNs.

Results: A total of 131 patients had a positive SLN and underwent completion axillary lymph node dissection. Multivariate analysis revealed that primary tumor >2 cm (P = .009), SLN metastasis >2 mm (P = .024), and lymphovascular invasion (P = .028) were independent predictors of positive NSLNs. The number of SLNs harvested was a significant negative predictor (P = .04). In our model, based on the presence of these factors, the positive predictive value was 100% for a score of 4.

Conclusions: The likelihood of positive NSLNs correlates with primary tumor size, size of the largest SLN metastasis, and presence of lymphovascular invasion. A scoring system incorporating these factors may help determine which patients would benefit from additional axillary surgery.

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Authors and Affiliations

  1. Departments of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Rosa F. Hwang MD, Kelly K. Hunt MD, Nadeem Mirza MD, Frederick C. Ames MD, Barry Feig MD, Henry M. Kuerer MD, PhD, S. Eva Singletary MD, Gildy Babiera MD, Funda Meric MD, Jeri S. Akins MPAS, PAC, Jessica Neely PAC & Merrick I. Ross MD

  2. Departments of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Savitri Krishnamurthy MD

  3. Surgical Breast Section, UT M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 444, Houston, TX, 77030

    Kelly K. Hunt MD

Authors
  1. Rosa F. Hwang MD
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  2. Savitri Krishnamurthy MD
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  3. Kelly K. Hunt MD
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  4. Nadeem Mirza MD
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  5. Frederick C. Ames MD
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  6. Barry Feig MD
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  7. Henry M. Kuerer MD, PhD
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  8. S. Eva Singletary MD
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  9. Gildy Babiera MD
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  10. Funda Meric MD
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  11. Jeri S. Akins MPAS, PAC
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  12. Jessica Neely PAC
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  13. Merrick I. Ross MD
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Correspondence to Kelly K. Hunt MD.

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Hwang, R.F., Krishnamurthy, S., Hunt, K.K. et al. Clinicopathologic Factors Predicting Involvement of Nonsentinel Axillary Nodes in Women With Breast Cancer. Ann Surg Oncol 10, 248–254 (2003). https://doi.org/10.1245/ASO.2003.05.020

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  • DOI: https://doi.org/10.1245/ASO.2003.05.020

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