Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node

Elizabeth A. Mittendorf, Kelly K. Hunt, Judy C Boughey, Roland Bassett, Amy C Degnim, Robyn Harrell, Min Yi, Funda Meric-Bernstam, Merrick I. Ross, Gildy V. Babiera, Henry M. Kuerer, Rosa F. Hwang

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Abstract

BACKGROUND AND OBJECTIVE: Sentinel lymph node (SLN) metastasis size is an important predictor of non-SLN involvement. The goal of this study was to construct a nomogram incorporating SLN metastasis size to accurately predict non-SLN involvement in patients with SLN-positive disease. METHODS: We identified 509 patients with invasive breast cancer with a positive SLN who underwent completion axillary lymph node dissection (ALND). Clinicopathologic data including age, tumor size, histology, grade, presence of multifocal disease, estrogen and progesterone receptor status, HER2/neu status, presence of lymphovascular invasion (LVI), number of SLN(s) identified, number of positive SLN(s), maximum SLN metastasis size and the presence of extranodal extension were recorded. Univariate and multivariate logistic regression analyses identified factors predictive of positive non-SLNs. Using these variables, a nomogram was constructed and subsequently validated using an external cohort of 464 patients. RESULTS: On univariate analysis, the following factors were predictive of positive non-SLNs: number of SLN identified (P < 0.001), number of positive SLN (P < 0.001), SLN metastasis size (P < 0.001), extranodal extension (P < 0.001), tumor size (P = 0.001), LVI (P = 0.019), and histology (P = 0.034). On multivariate analysis, all factors remained significant except LVI. A nomogram was created using these variables (AUC = 0.80; 95% CI, 0.75-0.84). When applied to an external cohort, the nomogram was accurate and discriminating with an AUC = 0.74 (95% CI, 0.68-0.77). CONCLUSION: SLN metastasis size is an important predictor for identifying non-SLN disease. In this study, we incorporated SLN metastasis size into a nomogram that accurately predicts the likelihood of having additional axillary metastasis and can assist in personalizing surgical management of breast cancer.

Original languageEnglish (US)
Pages (from-to)109-115
Number of pages7
JournalAnnals of Surgery
Volume255
Issue number1
DOIs
StatePublished - Jan 2012

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Nomograms
Lymph Nodes
Breast Neoplasms
Neoplasm Metastasis
Area Under Curve
Sentinel Lymph Node
Histology
Progesterone Receptors
Lymph Node Excision
Estrogen Receptors
Statistical Factor Analysis
Neoplasms
Multivariate Analysis
Logistic Models

ASJC Scopus subject areas

  • Surgery

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Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. / Mittendorf, Elizabeth A.; Hunt, Kelly K.; Boughey, Judy C; Bassett, Roland; Degnim, Amy C; Harrell, Robyn; Yi, Min; Meric-Bernstam, Funda; Ross, Merrick I.; Babiera, Gildy V.; Kuerer, Henry M.; Hwang, Rosa F.

In: Annals of Surgery, Vol. 255, No. 1, 01.2012, p. 109-115.

Research output: Contribution to journalArticle

Mittendorf, Elizabeth A. ; Hunt, Kelly K. ; Boughey, Judy C ; Bassett, Roland ; Degnim, Amy C ; Harrell, Robyn ; Yi, Min ; Meric-Bernstam, Funda ; Ross, Merrick I. ; Babiera, Gildy V. ; Kuerer, Henry M. ; Hwang, Rosa F. / Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. In: Annals of Surgery. 2012 ; Vol. 255, No. 1. pp. 109-115.
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abstract = "BACKGROUND AND OBJECTIVE: Sentinel lymph node (SLN) metastasis size is an important predictor of non-SLN involvement. The goal of this study was to construct a nomogram incorporating SLN metastasis size to accurately predict non-SLN involvement in patients with SLN-positive disease. METHODS: We identified 509 patients with invasive breast cancer with a positive SLN who underwent completion axillary lymph node dissection (ALND). Clinicopathologic data including age, tumor size, histology, grade, presence of multifocal disease, estrogen and progesterone receptor status, HER2/neu status, presence of lymphovascular invasion (LVI), number of SLN(s) identified, number of positive SLN(s), maximum SLN metastasis size and the presence of extranodal extension were recorded. Univariate and multivariate logistic regression analyses identified factors predictive of positive non-SLNs. Using these variables, a nomogram was constructed and subsequently validated using an external cohort of 464 patients. RESULTS: On univariate analysis, the following factors were predictive of positive non-SLNs: number of SLN identified (P < 0.001), number of positive SLN (P < 0.001), SLN metastasis size (P < 0.001), extranodal extension (P < 0.001), tumor size (P = 0.001), LVI (P = 0.019), and histology (P = 0.034). On multivariate analysis, all factors remained significant except LVI. A nomogram was created using these variables (AUC = 0.80; 95{\%} CI, 0.75-0.84). When applied to an external cohort, the nomogram was accurate and discriminating with an AUC = 0.74 (95{\%} CI, 0.68-0.77). CONCLUSION: SLN metastasis size is an important predictor for identifying non-SLN disease. In this study, we incorporated SLN metastasis size into a nomogram that accurately predicts the likelihood of having additional axillary metastasis and can assist in personalizing surgical management of breast cancer.",
author = "Mittendorf, {Elizabeth A.} and Hunt, {Kelly K.} and Boughey, {Judy C} and Roland Bassett and Degnim, {Amy C} and Robyn Harrell and Min Yi and Funda Meric-Bernstam and Ross, {Merrick I.} and Babiera, {Gildy V.} and Kuerer, {Henry M.} and Hwang, {Rosa F.}",
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T1 - Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node

AU - Mittendorf, Elizabeth A.

AU - Hunt, Kelly K.

AU - Boughey, Judy C

AU - Bassett, Roland

AU - Degnim, Amy C

AU - Harrell, Robyn

AU - Yi, Min

AU - Meric-Bernstam, Funda

AU - Ross, Merrick I.

AU - Babiera, Gildy V.

AU - Kuerer, Henry M.

AU - Hwang, Rosa F.

PY - 2012/1

Y1 - 2012/1

N2 - BACKGROUND AND OBJECTIVE: Sentinel lymph node (SLN) metastasis size is an important predictor of non-SLN involvement. The goal of this study was to construct a nomogram incorporating SLN metastasis size to accurately predict non-SLN involvement in patients with SLN-positive disease. METHODS: We identified 509 patients with invasive breast cancer with a positive SLN who underwent completion axillary lymph node dissection (ALND). Clinicopathologic data including age, tumor size, histology, grade, presence of multifocal disease, estrogen and progesterone receptor status, HER2/neu status, presence of lymphovascular invasion (LVI), number of SLN(s) identified, number of positive SLN(s), maximum SLN metastasis size and the presence of extranodal extension were recorded. Univariate and multivariate logistic regression analyses identified factors predictive of positive non-SLNs. Using these variables, a nomogram was constructed and subsequently validated using an external cohort of 464 patients. RESULTS: On univariate analysis, the following factors were predictive of positive non-SLNs: number of SLN identified (P < 0.001), number of positive SLN (P < 0.001), SLN metastasis size (P < 0.001), extranodal extension (P < 0.001), tumor size (P = 0.001), LVI (P = 0.019), and histology (P = 0.034). On multivariate analysis, all factors remained significant except LVI. A nomogram was created using these variables (AUC = 0.80; 95% CI, 0.75-0.84). When applied to an external cohort, the nomogram was accurate and discriminating with an AUC = 0.74 (95% CI, 0.68-0.77). CONCLUSION: SLN metastasis size is an important predictor for identifying non-SLN disease. In this study, we incorporated SLN metastasis size into a nomogram that accurately predicts the likelihood of having additional axillary metastasis and can assist in personalizing surgical management of breast cancer.

AB - BACKGROUND AND OBJECTIVE: Sentinel lymph node (SLN) metastasis size is an important predictor of non-SLN involvement. The goal of this study was to construct a nomogram incorporating SLN metastasis size to accurately predict non-SLN involvement in patients with SLN-positive disease. METHODS: We identified 509 patients with invasive breast cancer with a positive SLN who underwent completion axillary lymph node dissection (ALND). Clinicopathologic data including age, tumor size, histology, grade, presence of multifocal disease, estrogen and progesterone receptor status, HER2/neu status, presence of lymphovascular invasion (LVI), number of SLN(s) identified, number of positive SLN(s), maximum SLN metastasis size and the presence of extranodal extension were recorded. Univariate and multivariate logistic regression analyses identified factors predictive of positive non-SLNs. Using these variables, a nomogram was constructed and subsequently validated using an external cohort of 464 patients. RESULTS: On univariate analysis, the following factors were predictive of positive non-SLNs: number of SLN identified (P < 0.001), number of positive SLN (P < 0.001), SLN metastasis size (P < 0.001), extranodal extension (P < 0.001), tumor size (P = 0.001), LVI (P = 0.019), and histology (P = 0.034). On multivariate analysis, all factors remained significant except LVI. A nomogram was created using these variables (AUC = 0.80; 95% CI, 0.75-0.84). When applied to an external cohort, the nomogram was accurate and discriminating with an AUC = 0.74 (95% CI, 0.68-0.77). CONCLUSION: SLN metastasis size is an important predictor for identifying non-SLN disease. In this study, we incorporated SLN metastasis size into a nomogram that accurately predicts the likelihood of having additional axillary metastasis and can assist in personalizing surgical management of breast cancer.

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