PT - JOURNAL ARTICLE AU - PAOLO ORSARIA AU - EMANUELE CAREDDA AU - FEDERICA GENOVA AU - MARCO MATERAZZO AU - ILARIA CAPUANO AU - GIANLUCA VANNI AU - ALESSANDRA VITTORIA GRANAI AU - ADRIANO DE MAJO AU - ILARIA PORTARENA AU - PIERPAOLO SILERI AU - GIUSEPPE PETRELLA AU - LEONARDO PALOMBI AU - ORESTE CLAUDIO BUONOMO TI - Additional Nodal Disease Prediction in Breast Cancer with Sentinel Lymph Node Metastasis Based on Clinicopathological Features DP - 2018 Apr 01 TA - Anticancer Research PG - 2109--2117 VI - 38 IP - 4 4099 - http://ar.iiarjournals.org/content/38/4/2109.short 4100 - http://ar.iiarjournals.org/content/38/4/2109.full SO - Anticancer Res2018 Apr 01; 38 AB - Aim: The standard-of-care in breast cancer (BC) with positive sentinel lymph node (SLN) metastasis includes complete axillary lymph node dissection (ALND); however, almost half of such cases have no further tumor burden. This study aimed to assess the clinicopathological factors that predict non-SLN metastasis to define subgroups of SLN-positive patients in whom the axilla may be staged by SLN biopsy alone, while avoiding unnecessary overtreatment. Patients and Methods: The records of 191 patients with histologically-proven primary BC who underwent a positive (SLN) biopsy between 2005 and 2017 were reviewed. Patients with at least one tumor-involved SLN who underwent completion ALND were enrolled. Demographic and clinicopathological characteristics, including age, primary tumor size and histological grade, lymphovascular invasion, ratio of positive SLNs to the harvested SLNs, SLN metastasis size, and molecular subtype classification according to immunohistochemical biomarker status [estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)], were evaluated. Data were collected retrospectively and analyzed using the Mann–Whitney and Chi-square tests (statistical significance: p<0.05). Results: The incidence of non-SLN metastasis associated with positive SLN was 48.6% (93/191). The risk of additional nodal spread correlated with high sentinel nodal ratio >0.67 [odds ratio (OR)=2.55, p=0.032], luminal BC subtype (OR=2.67, p=0.06), HER2 overexpression (OR=0.4, p=0.016), and ER+PR−HER2− profile (OR=2.95, p=0.027). There was a tendency (statistically insignificant; p>0.05) toward higher incidence of non SLN metastasis with increasing age and histological grade, which could be attributed to the small sample size. Conclusion: According to this study, sentinel nodal ratio and BC subtypes as per ER, PR, and HER2 status significantly predicted the likelihood of additional lymphatic involvement. Validation of these parameters in prospective studies is indicated, and may help individualize treatment modalities.