Prospective Multicenter Comparison of Models to Predict Four or More Involved Axillary Lymph Nodes in Patients With Breast Cancer With One to Three Metastatic Sentinel Lymph Nodes

2009 ◽  
Vol 27 (34) ◽  
pp. 5707-5712 ◽  
Author(s):  
Gabrielle Werkoff ◽  
Eric Lambaudie ◽  
Eric Fondrinier ◽  
Jean Levêque ◽  
Fréderic Marchal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
False Negative ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Prospective Multicenter Study ◽  
Bootstrap Estimate

Purpose Three models have been developed to predict four or more involved axillary lymph nodes (ALNs) in patients with breast cancer with one to three involved sentinel lymph nodes (SLNs). Two scores were developed by Chagpar et al (Louisville scores excluding or including method of detection), and a nomogram was developed by Katz et al. The purpose of our investigation was to compare these models in a prospective, multicenter study. Patients and Methods Our study involved a cohort of 536 patients having one to three involved SLNs who underwent ALN dissection. We evaluated the area under the receiver operating characteristic curve (AUC), calibration (for the Katz nomogram only), false-negative (FN) rate, and clinical utility of the three models. Results were compared with the optimal logistic regression (OLR) model that was developed from the validation cohort. Results Among the 536 patients, 57 patients (10.6%) had ≥ four involved ALNs. The AUC for the Katz nomogram was 0.84 (95% CI, 0.81 to 0.86). The Louisville score excluding method of detection was 0.75 (95% CI, 0.72 to 0.78). The Louisville score including method of detection was 0.77 (95% CI, 0.74 to 0.79). The FN rates were 2.5% (eight of 321 patients), 1.8% (two of 109 patients), and 0% (zero of 27 patients) for the Katz nomogram and the Louisville scores excluding and including method of detection, respectively. The Katz nomogram was well calibrated. Optimism-corrected bootstrap estimate AUC of the OLR model was 0.86. Using this result as a reasonable target for an external model, the performance of the Katz nomogram was remarkable. Conclusion We validated the three models for their use in clinical practice. The Katz nomogram outperformed the two other models.

scholarly journals Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 127 ◽  
Author(s):  
Dalia Rukanskienė ◽  
Vincentas Veikutis ◽  
Eglė Jonaitienė ◽  
Milda Basevičiūtė ◽  
Domantas Kunigiškis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Nodes ◽  
False Negative ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Negative Results ◽  
False Negative Results

Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50–75% to 15–30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.

scholarly journals 18F-Alfatide II for the evaluation of axillary lymph nodes in breast cancer patients: comparison with 18F-FDG

2021 ◽  
Author(s):  
Jiang Wu ◽  
Jihong Tian ◽  
Yiyan Zhang ◽  
Hengshan Ji ◽  
Jingjing Sun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Visual Analysis ◽  
False Negative ◽  
Standardized Uptake Value ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Luminal B

Abstract 18F-Alfatide II has been translated into clinical use and been proven to have good performance in identifying breast cancer. In this study, we investigated 18F-Alfatide II for evaluation of axillary lymph nodes (ALN) in breast cancer patients and compared the performances with 18F-FDG. Methods: A total of 44 female patients with clinically suspected breast cancer were enrolled and underwent 18F-Alfatide II and 18F-FDG PET/CT within a week. Tracer uptakes in ALN were evaluated by visual analysis, semiquantitative analysis with maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and SUVmax ratio of target/non-target (T/NT). Results: Among 44 patients, 37 patients were pathologically diagnosed with breast cancer with metastatic (17 cases) or non-metastatic (20 cases) ALN. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of visual analysis were 70.59%, 90.00%, 81.08%, 85.71% and 78.26% for 18F-Alfatide II, 64.71%, 90.00%, 78.38%, 84.62% and 75.00% for 18F-FDG, respectively. By combining 18F-Alfatide II and 18F-FDG, the sensitivity significantly increased to 82.35%, the specificity was 85.00%, the accuracy increased to 83.78%, the PPV was 82.35% and the NPV significantly increased to 85.00%. Three cases of luminal B subtype were false negative for both 18F-Alfatide II and 18F-FDG. The other 2 false negative cases of 18F-Alfatide II were triple-negative subtype and 3 false negative cases of 18F-FDG were luminal B subtype too. The AUCs of three semi-quantitative parameters (SUVmax, SUVmean, T/NT) for 18F-Alfatide II were between 0.8 and 0.9, whereas those for 18F-FDG were more than 0.9. 18F-Alfatide II T/NT had the highest Youden index (76.5%), specificity (100%), accuracy (89.19%) and PPV (100%) among these semi-quantitative parameters. 18F-Alfatide II uptake as well as 18F-FDG uptake in metastatic axillary lymph nodes (MALN) was significantly higher than that in benign axillary lymph nodes (BALN). Both 18F-Alfatide II and 18F-FDG did not show difference in primary tumor uptake irrespective of ALN status. Conclusion: 18F-Alfatide II can be used in breast cancer patients to detect metastatic ALN, however, like 18F-FDG, with high specificity but relatively low sensitivity. The combination of 18F-Alfatide II and 18F-FDG can significantly improve sensitivity and NPV. 18F-Alfatide II T/NT may serve as the most important semi-quantitative parameter to evaluate ALN.

Sentinel lymph nodes navigation surgery for stage I or IIA breast cancer patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10784-10784
Author(s):  
M. Hirata ◽  
H. Kawabata ◽  
K. Tanaka
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Patient Survival ◽  
Sentinel Lymph Nodes ◽  
Stage I ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Significant Difference ◽  
Lymph Nodes Dissection

10784 Background: We applied indigocarmine for sentinel lymph nodes staining for Stage I or IIA breast cancer patients. We compared patient survival between sentinel lymph nodes navigastion surgery group and ordinary surgery with axillary lymph nodes dissection group. Methods: Patients consisted of 160 histologically proven breast cancer women (Stage I: 108 cases, Stage II: 52 cases, 51.8 ± 11.1 years, SN group) and other 320 breast cacner women (Stage I: 187 cases, Stage II: 146 cases, 53.4 ± 9.7 years, non-SN group). All patients underwent partial resection of their breast with histologically proven cancer cells negative margin (SN group: May 2000–December 2003, non-SN group: January 1996–December 2003). Fifteeen minutes before surgery, 0.4% Indigocarmine (10 ml) was injected around the tumor by use of 24 gauge syringe. Sentinel lymph node (SN) was defined as the stained lymph node. Intra operative cytology and histopathological examination was performed for SN and one or two lymph nodes around the SN. When any cancer cells were found in either of SN or the lymph nodes around the SN, axillary lymph nodes dissection was performed. When all of SN and several lymph nodes around the SN were diagnosed as cancer cells negative, axillary lymph nodes dissection was omitted. Patient survival and disease free survival were calculated by Kaplan-Meier method. Results: About patients characteristics including age, diameter of the tumor, hormone receptor status, treatment after surgery, etc., no significant difference was found between two groups. We could find SN in 156 patients (97.5%) out of 160 cases in SN group. Four years patient survival was 97.6% (stage I, SN group), 96.6% (stage I, non SN group), and 96.6% (stage IIA, SN group), 93.5% (stage IIA, non SN group), respectively (no significant difference). Four years disease free survival was 97.6% (stage I, SN group), 95.4% (stage I, non SN group), and 82.5% (stage IIA, SN group), 86.4% (stage IIA, non SN group), respectively (no significant difference). Conclusions: Sentinel lymph nodes navigation surgery for stage I or IIA breast cancer patients by use of 0.4% Indigocarmine revealed comparable patient survival and disease free patient survival to ordinary surgery. No significant financial relationships to disclose.

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