Cancer Management and Research (Feb 2020)

A New Model Incorporating Axillary Ultrasound After Neoadjuvant Chemotherapy to Predict Non-Sentinel Lymph Node Metastasis in Invasive Breast Cancer

  • Zhang K,
  • Zhu Q,
  • Sheng D,
  • Li J,
  • Chang C

Journal volume & issue
Vol. Volume 12
pp. 965 – 972

Abstract

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Kai Zhang,* Qian Zhu,* Danli Sheng, Jiawei Li, Cai Chang Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cai ChangFudan University Shanghai Cancer Center, No. 270, Dong’an Road, Xuhui District, Shanghai 200032, People’s Republic of ChinaTel +86 180 1731 2605Fax +86 21 6417 4774Email [email protected]: Few models with good discriminative power have been introduced to predict the risk of non-sentinel lymph node (non-SLN) metastasis in breast cancer after neoadjuvant chemotherapy (NAC). We aimed to develop a new and simple model for predicting the probability of non-SLN metastasis in breast cancer and facilitate the selection of patients who could avoid unnecessary axillary lymph node dissection following NAC.Patients and Methods: A total of 298 patients diagnosed with invasive breast cancer, who underwent SLN biopsy after completing NAC and subsequently breast surgery, were included and classified into the training set (n=228) and testing set (n=70). Univariate and multivariate analyses were used to select factors that could be determined prior to breast surgery and significantly correlated with non-SLN metastasis in the training set. A logistic regression model was developed based on these factors and validated in the testing set.Results: Nodal status before NAC, post-NAC axillary ultrasound status, SLN number, and SLN metastasis number were independent predictors of non-SLN metastases in breast cancer after NAC. A predictive model based on these factors yielded an area under the curve of 0.838 (95% confidence interval: 0.774– 0.902, p< 0.001) in the training set. When applied to the testing set, this model yielded an area under the curve of 0.808 (95% confidence interval: 0.609– 1.000, p= 0.003).Conclusion: A new and simple model, which incorporated factors that could be determined prior to breast surgery, was developed to predict non-SLN metastasis in invasive breast cancer following NAC. Although this model performed excellently in internal validation, it requires external validation before it can be widely utilized in the clinical setting.Keywords: breast carcinoma, neoadjuvant chemotherapy, sentinel lymph node, ultrasonography

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