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J Breast Cancer. 2017 Sep;20(3):270-278. doi: 10.4048/jbc.2017.20.3.270.

Epub 2017 Sep 22.

Development of a Nomogram to Predict N2

or N3 Stage in T1-2 Invasive Breast Cancer
Patients with No Palpable
Lymphadenopathy.
Kim I1, Ryu JM1, Kim JM1, Choi HJ1, Lee SK1, Yu JH1, Lee JE1, Kim
SW1, Nam SJ1.
Author information

Abstract
PURPOSE:
Subsequent to the American College of Surgeons Oncology
Group (ACOSOG) Z0011 and After Mapping of the Axilla:
Radiotherapy or Surgery (AMAROS) trials, complete axillary
lymph node dissection is not routinely performed, even in cases
where metastatic sentinel lymph nodes are detected. We
investigated the percentage of N2 or N3 stages in T1-2 invasive
breast cancer patients with no lymphadenopathy and
developed a nomogram to predict the possibility of N2 or N3
stages in these patients.
METHODS:
We retrospectively reviewed the charts of invasive breast
cancer patients who were clinically N0 stage, but had a positive
sentinel or non-sentinel lymph node detected on sentinel lymph
node biopsy. The association of potential risk factors with
known outcomes (N2 or N3 stages) was tested using logistic
regression analysis. Variables with p<0.05 in the multivariate
analysis were included in the nomogram. Internal performance
validation was carried out using a 5-fold cross validation
method.
RESULTS:
Among a total of 1,437 patients, 1,355 patients had stage N1
disease (94.3%), while 82 had stage N2 or N3 disease (5.7%).
Multivariate stepwise logistic regression analysis revealed
lymphovascular invasion (p=0.008), T2 stage (p=0.026),
metastatic lymph node ratio (p<0.001), and perinodal extension
(p<0.001) as independent predictors of N2 or N3 stages. A
nomogram was developed based on these factors. The area
under the curve estimated from the receiver operating
characteristic graph was 0.8050 in the model set and 0.8246 in
the test set.
CONCLUSION:
Our nomogram can be employed for the prediction of N2 or N3
stage among cases fulfilling the ACOSOG Z0011
or AMAROS criteria.
KEYWORDS:
Breast neoplasms; Lymph node excision; Nomograms; Sentinel lymph
node biopsy
PMID:
 28970853

PMCID:

PMC5620442

DOI:

10.4048/jbc.2017.20.3.270
Free PMC Article
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