The predictive probability of four different breast cancer nomograms for non-sentinel axillary lymph node metastasis in positive sentinel lymph node biopsy.

568 Background: Axillary lymph node metastasis is still the important prognostic factor in the management of breast cancer (BC). Where we have moved towards axillary conservation in clinically node negative (cN0), the debate on what after 1-2 sentinel lymph nodes positive (SLN+ve) still continues. The ideal situation would be wherein we can accurately predict which patient has a risk of additional non SLN+ve. Several nomograms have been developed to predict the risk of NonSLN+ve. But in view of the differences in tumor size and nodal burden between our patients and the western data, we conducted a study to validate some of these nomograms in our cohort of early BC with positive LN on Low axillary sampling (LAS). Methods: Clinico-pathological data was collected for operable BC (OBC) with cN0 who underwent upfront SLNB or AS. This was entered into the various nomograms and the probability of the Non SLN+ve was calculated. Nomograms with AUC of greater than 0.7 were pre-defined as considerable discrimination. Results: From 2013 to 2018, 2350 women with cN0 OBC underwent LAS. Of which, 670 (28.5%) had a positive node on LAS. Median pT size was 3 cm with 327 (48%), LVI +ve 152 (77%) ENI +ve, 525 (78.4%) Hormone receptor +ve and 485 (72.4%) grade 3 tumors. Of 670, 239 (35.7%) had a NonSLN+ve on completion axillary dissection. The AUC values for nomograms included,ie. MSKCC, MDAnderson, Tenon, Cambridge, Shanghai, Mayo clinic and Turkish were 0.769, 0.77, 0.55, 0.74, 0.65, 0.529, 0.563 respectively. Only three nomograms, MDA, MSKCC and Cambridge had an AUC of more than 0.7. However, they were associated with poor sensitivity and specificity and high FNR (Table) making them clinically unreliable for this cohort. Conclusions: All 7 nomograms were not validated in our study. The larger T size and higher nodal burden of our cohort may be responsible for the same. We thus need to develop an Indian nomogram to predict the risk of non SLN+ve for our patients. [Table: see text]

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Factors that determine whether a patient receives completion axillary lymph node dissection after a positive sentinel lymph node biopsy in breast cancer in British Columbia

Canadian Journal of Surgery ◽

10.1503/cjs.007810 ◽

2011 ◽

Vol 54 (4) ◽

pp. 237-242 ◽

Cited By ~ 6

Author(s):

Nava Aslani

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Axillary Lymph Node ◽

Positive Sentinel Lymph Node ◽

Lymph Node Biopsy ◽

Axillary Lymph ◽

Node Dissection ◽

Node Biopsy

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Adenomyoepithelioma With Myoepithelial Carcinoma of the Breast With Axillary Lymph Node Metastasis: Two Case Reports and Review of the Literature

International Surgery ◽

10.9738/intsurg-d-17-00080.1 ◽

2019 ◽

Vol 104 (5-6) ◽

pp. 203-210

Author(s):

Hye Yoon Lee ◽

Jeong Hyun Lee ◽

Seung Pil Jung ◽

Insun Kim ◽

Jeoung Won Bae

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Lymph Node Biopsy ◽

Axillary Lymph Node Metastasis ◽

Axillary Lymph ◽

Myoepithelial Carcinoma ◽

Carcinoma Of The Breast ◽

Node Metastasis ◽

Node Biopsy

Objectives Adenomyoepithelioma (AME) of the breast exhibits characteristic proliferation of the epithelial and myoepithelial cells. Most AMEs are benign, but the 2 inherent cell types can become malignant. The present study reports 2 cases of AME with myoepithelial carcinoma of the breast, one with axillary lymph node metastasis. Methods A modified radical mastectomy was performed in a 67-year-old woman, because a sentinel lymph node biopsy revealed one metastatic lymph node composed of a myoepithelial carcinoma component. Despite receiving radiotherapy and chemotherapy, the patient died from lung and brain metastases 21 months later. In the second case, breast-conserving surgery with sentinel lymph node biopsy was performed in a 55-year-old woman. Following additional treatment with radiotherapy and chemotherapy, there were no signs of recurrence or metastasis. Results The tumors of the 2 patients were diagnosed as malignant, based on their high mitotic rate and severe nuclear atypia. Conclusions Based on previously reported cases with distant metastases, the prognosis of myoepithelial carcinoma is poor. Myoepithelial carcinoma should be followed up with careful screening and treated aggressively.

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