Retrospective Evaluation of the Preoperative Features of Breast Cancer and Sentinel Lymph Node Metastasis

Abstract

Objective: Determining the presence of metastasis in the axillary lymph nodes using preoperative data in breast cancer has been studied previously. Formulas and nomogram programs that calculate the relationship between parameters and axillary lymph node metastases are presented. It is controversial whether current calculations give the same accuracy across all ethnic groups. We aimed to validate the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram results for the prediction of sentinel lymph node (SLN) metastasis in patients with breast cancer in Turkey. Method: The clinical records, pathology results, and surgery reports of 400 patients who underwent surgery were examined. Sensitivity, specificity, positive and negative predicated values, and area under the curve (AUC) values were calculated using a nomogram developed by the MSKCC. Results: Frozen section results of SLN examination of the patients were positive in 101 of the 400 patients. The relationship between nomogram calculation and sentinel positivity was evaluated using the receiver operating characteristic curve (ROC); AUC 0,699, p<0.001. When sentinel lymph node biopsy (SLNB) status and nomogram risk ratio were compared, the sensitivity was calculated as 85% and the specificity was 40%. The negative predicated value was 68% and the positive predicated value was 63%. The ROC curve calculation reached a risk value of 77% as the optimal criterion. When this value was reached, the nomogram’s sensitivity was 96% and specificity was 14.8%. Conclusion: Although there was a significant relationship in the calculation of MSKCC nomograms in our patient group, it was found to show an excessive risk of metastasis. Both sensitivity and specificity values were found to be significantly lower than those in western studies, especially when optimal risk values were considered. Our results were found to be more similar to the studies on the Asian population when compared with the studies based on European and American populations. It was concluded that different ethnic populations may have their own characteristics and that a nomogram calculation that is specifically designed for each ethnic population may be required.

Keywords

• breast cancer
• breast surgery
• nomogram
• sentinel lymph node