scholarly journals Significance of peritoneal washing cytology in the accurate staging of malignant ovarian tumors

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Rubina Gulzar ◽  
Ruqaiya Shahid ◽  
Shazia Mumtaz ◽  
Jahan Ara Hasan
Keyword(s):  
Lymph Node ◽  
Tumor Size ◽  
Ovarian Tumors ◽  
Peritoneal Cytology ◽  
Capsular Invasion ◽  
Accurate Staging ◽  
Peritoneal Washing ◽  
Peritoneal Washing Cytology ◽  
The Mean ◽  
Omental Metastasis

Objectives: To identify the percentage of ovarian cancers with positive peritoneal cytology and to correlate the positive cytology with the prognostic factors. Methods: This retrospective, cross-sectional study, evaluated the data of surgical specimens of malignant ovarian tumors, received in the Department of Pathology, Dow University of Health Sciences over a period of three years. The peritoneal cytology was correlated with these prognostic parameters: the size of the tumor, stage, capsular invasion, omental, and lymph node metastasis. Results: Eighty malignant ovarian tumors were diagnosed. Serous carcinoma was the most common ovarian tumor, diagnosed in 24 (30.0%) cases, followed by endometrioid carcinoma in 17 (21.25%) and Granulosa cell tumor in 11 (13.75%) cases. The mean age of the patients was 41.91 years (range 7-71 years). The mean size of the tumors was 10.03 cm (SD 5.62 cm). The ovarian capsular invasion was present in 27 (33.75%) tumors. Peritoneal cytology was positive in 10/24 cases, with a detection rate of 41.66%. Omentum was involved in 12/34 (35.29%) cases. Lymph node dissection was performed in three cases, two were reported as positive for metastasis. Peritoneal cytology significantly correlated with the tumor size (p=0.045), and with ovarian capsular invasion (p=0.054) and omental metastasis (p=0.052). Most of the tumors were staged as FIGO stage IA. Conclusion: Peritoneal cytology correlates with the tumor size, stage, and omental metastasis of the malignant ovarian tumors. It should be routinely performed at the time of surgery for the optimal staging of the patients. doi: https://doi.org/10.12669/pjms.38.1.4393 How to cite this:Gulzar R, Shahid R, Mumtaz S, Hassan JA. Significance of peritoneal washing cytology in the accurate staging of malignant ovarian tumors. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4393 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals An observational study of cytopathological analysis of ascitic fluid or peritoneal washings cytology in ovarian neoplasms: correlation with histopathological parameters

2018 ◽  
Vol 6 (9) ◽  
pp. 3010
Author(s):  
Priya Jaswani ◽  
Sonal Gupta
Keyword(s):  
Ascitic Fluid ◽  
Peritoneal Metastasis ◽  
Ovarian Neoplasms ◽  
Ovarian Tumors ◽  
P Value ◽  
Peritoneal Cytology ◽  
Histologic Type ◽  
Capsular Invasion ◽  
Study Results ◽  
Omental Metastasis

Background: Analysis of ascitic fluid and peritoneal washing cytology serves as a useful predictor of ovarian surface involvement and peritoneal metastasis even in the absence of clinical omental spread. The aim of the current study is to correlate peritoneal cytology with various histologic features of ovarian cancers.Methods: It is a retrospective study.  A total of 30 cases of ovarian neoplasms were included in the study. Results of peritoneal cytology were correlated with various histologic features of ovarian tumors including histologic type, grade, tumor size, capsular invasion, and omental metastasis, using chi-square test. A p value of <0.05 was considered as statistically significant.Results: Out of the 30 cases of ovarian tumors involved in the study, twenty-five cases were surface epithelial tumors, two sex-cord stromal tumors, one germ cell tumor, one primary ovarian lymphoma and one metastatic carcinoma. Capsular invasion was seen in 56.3 % of the cases, and omental metastasis in 46.6 % of the cases. A significant positive correlation was seen between positive peritoneal cytology and capsular invasion and omental metastasis with a p value of <0.001.Conclusions: Peritoneal fluid cytology is an indicator of peritoneal metastasis. Positive cytology also correlates with capsular invasion and histologic type in ovarian tumors. Therefore, it should always be used as an adjunctive tool in the surgical management of ovarian tumors.

An Evaluation of Frozen Section and Lymph Node Dissection Results for Mucinous Ovarian Tumors

2018 ◽  
Vol 28 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Marisa R. Moroney ◽  
Miriam D. Post ◽  
Amber A. Berning ◽  
Jeanelle Sheeder ◽  
Bradley R. Corr
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Frozen Section ◽  
Ovarian Tumors ◽  
Node Dissection ◽  
Cross Sectional ◽  
Mucinous Histology ◽  
Final Pathology ◽  
Mucinous Ovarian Tumors

ObjectivesIntraoperative frozen section has greater than 90% accuracy for ovarian tumors; however, mucinous histology has been shown to be associated with increased frozen section inaccuracy. Recent data demonstrate that primary ovarian mucinous carcinomas have no lymph node involvement, even when extraovarian disease is present, and therefore may not require lymph node dissection. Our primary objective is to evaluate the accuracy of identifying mucinous histology on frozen section.Methods/MaterialsA cross-sectional review of mucinous ovarian tumors in surgical patients at one institution from 2006 to 2016 was performed. Cases reporting a mucinous ovarian tumor on frozen section or final pathology were identified. Frozen section results were compared with final diagnosis to calculate concordance rates. Analyses with χ2 and t tests were performed to identify variables associated with pathology discordance.ResultsA total of 126 mucinous ovarian tumors were identified. Of these, 106 were reported as mucinous on frozen section and 103 (97.2%) were concordant on final pathology. Discordant cases included 2 serous and 1 clear cell tumor. Among the 103 mucinous tumors, classification as malignant, borderline, or benign was concordant in 74 (71.8%) of 103 cases, whereas 22 (21.4%) of 103 were discordant and 7 (6.8%) were deferred to final pathology. Lymph node dissection was performed in 33 cases; the only case with lymph node metastasis was a gastrointestinal mucinous adenocarcinoma. Discordance between frozen section and final pathology was associated with larger tumor size and diagnosis other than benign: discordant cases had a mean tumor size of 21.7 cm compared with 14.4 cm for concordant cases (P < 0.001), and 93.5% of discordant cases were borderline or malignant, compared with 30.5% of concordant cases (P < 0.001).ConclusionsIntraoperative identification of mucinous histology by frozen section is reliable with a concordance rate to final pathology of 97.2%. No lymph node metastases were present in any malignant or borderline primary ovarian cases.

The Association of Body Mass Index and Adverse Clinico-Pathological Characteristics of Non-Metastatic Breast Cancer Among Patients from Saudi Arabia

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 8-8
Author(s):  
Bashayer Alghamdi ◽  
Reema Alghamdi ◽  
Raghad Khallaf ◽  
Konooz faisal ◽  
Raghad Bishnaq ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Mass Index ◽  
Saudi Arabia ◽  
Lymph Node ◽  
Body Mass ◽  
Tumor Size ◽  
P Value ◽  
Axillary Lymph ◽  
Receptor Status ◽  
The Mean

Background: Obesity is a global health problem, especially in the Arab region, the prevalence of obesity is increasing. High body mass index (BMI) is a risk factor for many diseases, including cancer. Noticeably, breast cancer (BC) cases in Saudi Arabia occur at a younger age than western countries and different life style behaviours such as maintaining healthy body weight and physical activity may play a role in this. In this study, we aimed to investigate the association between BMI and BC clinicopathological features. Methods: This retrospective study was conducted by reviewing the records of females diagnosed with non-metastatic BC over four years. The association between BMI and patients’ demographics, BC histological type, receptor status, differentiation grade, tumor size, involvement of axillary lymph node, and performed procedures was analysed. Result: We studied 315 patients with non-metastatic BC. The mean age at the time of diagnosis was 52.43 years ±11.63. The mean BMI was 30.21±5.77. The mean tumor size was 3.19 cm ± 3.52. We found that the mean age of diagnosis is significantly greater in obese women than other BMI groups with a P-value = 0.025. A significant relationship was observed between BMI classification and tumor size in obese female patients aged ⩾ 40 years with P-value=0.022 Conclusion: The relationship between BMI and BC is still not clear, in this study we found an association with age at diagnosis and tumor size in older patients, characteristics as histological types, receptor status, lymph node involvement, and grade were not statistically significant.

scholarly journals Incidence and Clinical Significance of Delphian Lymph Node Metastasis in Unilateral Papillary Thyroid Carcinoma

2020 ◽  
Author(s):  
Wei Liu ◽  
Zhenglin Wang ◽  
Cong Wang ◽  
Zhilong Ai
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Clinical Significance ◽  
Tumor Size ◽  
Frozen Section ◽  
Extrathyroidal Extension ◽  
Capsular Invasion ◽  
Papillary Thyroid

Abstract Background: Some studies have reported that Delphian lymph node (DLN) metastasis is associated with a poor prognosis of papillary thyroid carcinoma (PTC), but the number of the available studies is limited and the results are inconsistent. The aim of this investigation was to study the incidence and clinical significance of DLN metastasis in patients with unilateral PTC.Methods: This was a cross-sectional study from January 2016 to December 2019. The data were obtained from the department of general surgery in Shanghai Zhongshan Hospital affiliated to Fudan University. This study included 522 patients with unilateral PTC and had DLN harvested. The associations between DLN metastasis and the clinical characteristics of the patients, i.e. age, sex, tumor size, multifocality, capsular invasion, extrathyroidal extension, central lymph nodes (CLN) metastasis (excluding DLN), and lateral lymph nodes (LLN) metastasis was analyzed.Results: Among all the 522 patients, 133 (25.5%) patients had metastasized DLN lymph nodes. DLN metastasis was significantly associated with age (p = 0.047), male (p < 0.001), larger tumor size (p < 0.001), capsular invasion (p < 0.001), extrathyroidal extension (p = 0.004), tumor location in upper third (p = 0.003), other CLN metastasis (p < 0.001), number of positive CLN (excluding DLN) (p < 0.001), LLN metastasis (p = 0.036), number of positive LLN (p = 0.004) and number of DLN removed (p = 0.043). No association was found between DLN metastasis and multifocality, number of CLN removed and number of LLN removed.Conclusions: DLN metastasis is associated with some adverse prognostic markers of PTC. If the DLN is positive on intraoperative frozen section, careful dissection of CLN and careful evaluation of LLN are essential, and intensive follow-up should be warranted.

Is there an Optimal Surgical Approach to Neuroendocrine Tumors of the Ampulla? A Single Institution Experience over 15 Years

2016 ◽  
Vol 82 (7) ◽  
pp. 637-643 ◽  
Author(s):  
Gillian G. Baptiste ◽  
Lauren M. Postlewait ◽  
Cecilia G. Ethun ◽  
Nina Le ◽  
Maria C. Russell ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neuroendocrine Tumors ◽  
Surgical Approach ◽  
Tumor Size ◽  
Regional Lymph Node ◽  
Ki 67 ◽  
Advanced Tumor ◽  
Tumor Node Metastasis Stage ◽  
The Mean ◽  
Aggressive Tumors

Neuroendocrine tumors (NETs) of the ampulla of Vater are rare neoplasms accounting for a small fraction of gastroenteropancreatic NETs. The optimal surgical approach remains controversial. This study aimed to define the optimal approach in patients with ampullary NETs. Patients who underwent resection of ampullary NETs from 2000 to 2014 were analyzed. Fourteen patients with well-differentiated, nonfunctional NETs were identified. The mean age was 60 ± 15 years, and nine (64%) were male. The mean tumor size was 1.6 ± 0.9 cm and the majority (61%) had an advanced tumor-node-metastasis stage. Eight (57%) patients underwent pancreaticoduodenectomy (PD) and six (43%) underwent transduodenal ampullectomy (TA). Although the mean tumor size was similar (1.7 vs 1.5 cm), the majority (75 vs 20%) of PD patients demonstrated a trend toward more aggressive tumors, characterized by advance T stage in 25 vs 0 per cent, lymph node positivity in 88 vs 17 per cent, and elevated proliferative index (Ki-67) in 25 vs 0 per cent. Complete resection (R0) was achieved in all PD patients versus 75 per cent in TA patients. There was no difference in major complication rate (50 vs 33%). In the TA group, one (17%) patient recurred and two (33%) patients died, whereas only one (13%) patient died in the PD group and no patients recurred. In conclusion, ampullary tumors can be aggressive tumors characterized by high regional lymph node involvement. A transduodenal approach may provide an inadequate oncological resection and thus has the potential to understage ampullary NETs. In the era of increasing therapeutic options for gastroenteropancreatic NETs, accurate staging is crucial and appropriate oncologic resection via PD for ampullary NETs should be considered.

Lymph Node Metastatic Patterns and Survival Predictors Based on Tumor Size in Pancreatic Ductal Adenocarcinoma

2020 ◽  
Author(s):  
Ning Pu ◽  
Qiangda Chen ◽  
Wei Gan ◽  
Benedict Kinny-Köster ◽  
Hanlin Yin ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Tumor Size ◽  
Metastatic Potential ◽  
Ductal Adenocarcinoma ◽  
Cancer Specific Survival ◽  
Node Positive Disease ◽  
Mass Size ◽  
Metastatic Patterns ◽  
The Mean

Abstract BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Its larger mass size is widely acknowledged to be associated with increased lymph node (LN) metastatic potential. However, the quantitative relationships between tumor size and LN metastasis or survival remain unclear. Thus, this study aims to quantitatively identify the objective relationship between tumor size and prevalence of LN metastases across primary tumor size spectrums.METHODS: 9,958 resected PDAC patients without distant metastasis were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. The prevalence of LN metastases, LN ratio (LNR) and N2/N1 ratio were assessed amongst different tumor sizes, and the relationships were depicted by matched curves. RESULTS: In the enrolled cohort, age, tumor site, grade, American Joint Committee on Cancer (AJCC) 8th node staging, tumor size, chemotherapy and radiotherapy were identified as significant independent predictors for overall survival (OS) and cancer-specific survival (CSS). For tumors within 1-40 mm in size, the prevalence of node positive disease is closely modelled using a logarithmic formula [0.249×ln (size) + 0.452] × 100%, and then fluctuated between 70.0% and 80.0% when beyond 40 mm. The mean LNR increased in a stepwise manner as tumor size increased from 1-5 mm (LNR=0.024) to 41-45 mm (LNR=0.177); then, beyond 45 mm, it plateaued near 0.170. N2/N1 ratio gradually increased along with tumor size from 1-5 mm (N2/N1=0.286) to 41-45 mm (N2/N1=1.016), and when tumor size reached to 41-45 mm or more, the ratio stabilized around 1.000. CONCLUSION: Regional LN involvement demonstrated a logarithmic growth with increasing tumor sizes in resectable PDAC patients. The probability of metastasis in each regional LN for resectable PDAC patients with tumors greater than 40 mm in size was near 17.0% and their overall prevalence of LN metastasis was 70%-80%. Among which, 50% of patients had an N2 stage.

Evaluation of the Prognostic Value of Peritoneal Cytology in Patients with Endometrial Cancer: A Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Fariba Binesh ◽  
Mohammad Taghi Moravej ◽  
Safiyehsadat Heydari ◽  
Mahdi Aghabagheri ◽  
Hamidreza Dehghan
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Survival Rates ◽  
Cancer Staging ◽  
Publication Date ◽  
Peritoneal Cytology ◽  
Eligibility Criteria ◽  
Peritoneal Washing ◽  
Peritoneal Washing Cytology

Objective: In 1988, a new conception for endometrial cancer staging was introduced by Fédération Internationale de Gynecologie et d'Obstétrique (FIGO). In addition to pathologic development, peritoneal cytology played an important role in the staging. The goal of peritoneal cytology was to identify hidden and microscopic extensions outside the uterus. In 2009, the system was reviewed; one of the changes was removing the peritoneal cytology. The aim of this review is to evaluate the effect of peritoneal cytology on the survival of patients with endometrial cancer. Methods and analysis: This protocol is reported based on the PRISMA-P guideline. We will search "endometrial cancer," "peritoneal washing," and any other relevant words on PubMed, Cochran, EMBASE, and Scopus databases. The eligibility criteria are: All original studies performed on patients with endometrial cancer, evaluated survival, and performed peritoneal washing cytology. Only one of the non-English studies with the same respect will be included according to the research team's opinion. Also, the most recent paper among multiple articles about a single study is chosen. It should be noted that there will not be any restrictions regarding the language and publication date. For quality assessment, we will use the quality in prognosis (QUIPS) tool.  If possible, a meta-analysis will also be performed using a rndom effects model, and overall survival rates and confidence intervals will be reported. Heterogeneity will be tested by using the I2 index and Cochrane's Q test. Subgroup analysis will be performed to handle the heterogeneity. The publication bias will be assessed in the presence of 10 or more relevant articles. If there is no chance of meta-analysis, the result will be reported qualitatively. Discussion: The resulting review will provide valuable information regarding the prognostic value of peritoneal cytology in patiens with endometrial cancer.

scholarly journals Correlation of axillary lymph nodes involvement and Nottingham prognostic index with various histopathologic prognostic factors in invasive breast carcinoma

2019 ◽  
Vol 6 (4) ◽  
pp. 1187
Author(s):  
Ashish Shukla ◽  
S. C. Jain ◽  
Manish Swarnkar
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Prognostic Index ◽  
Nottingham Prognostic Index ◽  
The Mean ◽  
Lymph Node Stage

Background: Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women. The clinical management of this tumor relies on various prognostic factors, most importantly lymph node stage, tumor size and histologic grade. There have been attempts at integration of these factors into meaningful indices. The most widely used of these is the Nottingham prognostic index (NPI), this study was aimed to evaluate the NPI in a group of breast cancer patients and to correlate NPI with other clinical and histo-morphological features.Methods: This was a two-year prospective, observational study was done in the Department of Surgery, Tertiary Care Teaching Hospital of Maharashtra, India. A total of 50 patients who presented with invasive carcinoma of breast from October 2016 to October 2018 were enrolled.Results: Most of the patients belonged to the age group of 41 to 50 years (34%) and the mean age of patients in study was 51.18±11.93 years. Left breast was more affected (62%) than the right breast (38%). Majority of the cases had tumor size of <5 cm (70%) and the mean size of was 4.65±1.89 cms. Majority of the patients (62%) belonged to Bloom Richardson (BR) Grade II and 24% of the patients were ER and PR positive. Lymphovascular invasion was present in 74% of the patients. There was significant positive correlation between tumor size and lymph node involvement. Significant correlation was noted between NPI score and tumor size, positive lymph nodes and BR grade. The mean NPI scores in patients with lymphovascular invasion were noted as 4.92±1.05, compared to 4.83±0.93 among the patients in whom lymphovascular invasion was absent (p=0.779). The mean NPI scores in patients with ER-, PR- were slightly high (4.91±0.94) compared to ER+, PR+ patients (4.76±1.19) (p=0.778).Conclusions: NPI is an essential and valuable prognostic indicator, which should be incorporated in breast cancer reporting by the histopathologists and also primary tumor size, lymph node stage and histological grade which provides further guideline to treating clinicians to choose treatment modalities for the patient and in deciding to follow up plan as well.

scholarly journals A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Zheyu Yang ◽  
Yu Heng ◽  
Qiwu Zhao ◽  
Zichao Cao ◽  
Lei Tao ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Papillary Thyroid Cancer ◽  
Tumor Size ◽  
Capsular Invasion ◽  
Papillary Thyroid ◽  
Skip Metastasis ◽  
Node Metastasis ◽  
Central Lymph

Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size &gt; 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.

Predictions for positive nodes in breast cancer using computerized modeling.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 16-16
Author(s):  
U. Gawlick ◽  
K. Hewitt ◽  
P. Tamayo ◽  
M. C. Mone ◽  
H. J. Hansen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Bayesian Model ◽  
Receptor Expression ◽  
National Study ◽  
Axillary Staging ◽  
Axillary Lymph ◽  
Axillary Nodes ◽  
The Mean

16 Background: The accuracy and consistency of sentinel lymph node (SLN) biopsy for axillary staging in breast cancer has been well established by multiple studies. Although the standard of care has been to perform a completion axillary lymph node dissection (ALND) on patients who have a positive sentinel node, recent data (ACOSG Z0010, Z0011 and NSABP B-32) suggests that an ALND may be avoided in certain subsets of patients. To further study this question, we used a Bayesian model to predict the probability of finding disease in the ALND for breast cancer. Methods: All SLN procedures performed by a single surgeon, for clinical T1-T2 N0 disease between September 2000 and March 2009 were retrospectively reviewed under an IRB approved protocol. Demographic, disease and surgical procedural variables were collected. Values are reported as mean ± standard deviation. A Bayesian model, a standard statistical model frequently used in medicine, was used to identify variables that could predict a positive ALND. Results: A total number of 235 SLN procedures were reviewed. The mean patient age was 58.6 ± 11.8 (range 28-88), tumor size was 1.8 ± 1.3 cm (range 0.2-7.4), and BMI was 28 ± 6.1. The number of SLN found was 3.6 ± 1.9 (range 0-10), and in 2 cases no SLN were found, for an overall failure rate of 0.85%. A total of 73 ALND were performed in this group; 27 cases had ALND as national study participants randomized to ALND, 44 cases for positive SLN, and 2 cases in which no SLN could be identified. The mean number of axillary lymph nodes removed was 14.8 ± 7 and the mean number of positive axillary nodes was 2.7 ± 4.1. Tumor size, tumor grade, number of positive SLN by hematoxylin and eosin staining, and a low technetium count of the first SLN were found to be significant predictors of positive axillary nodes during a completion ALND. There was also a trend for progesterone receptor expression as a predictor of axillary disease. Conclusions: A model to predict a positive ALND for breast cancer is presented. We found tumor characteristics, number of positive SLN and low technetium count for first SLN to be predictors for finding axillary disease. Further studies are needed to validate our model as a means of sparing women an ALND who have a low probability of finding additional breast disease.

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