Nomogram for prediction of level 2 axillary lymph node metastasis in proven level 1 node-positive breast cancer patients
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Yanlin Jiang1,*, Hong Xu2,*, Hao Zhang3, Xunyan Ou3, Zhen Xu3, Liping Ai3, Lisha Sun4 and Caigang Liu1
1Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110004, China
2Department of Breast Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital & Institute), Shenyang, Liaoning Province, 110042, China
3Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, the Second Hospital of Dalian Medical University, Dalian, 116027, China
4Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang, 110013, China
*Share co-first authorship
Caigang Liu, email: [email protected]
Keywords: breast cancer, level 2 axillary lymph node metastasis, level 1 axillary lymph node metastasis, nomogram
Received: July 08, 2017 Accepted: August 08, 2017 Published: August 22, 2017
Background: The current management of the axilla in level 1 node-positive breast cancer patients is axillary lymph node dissection regardless of the status of the level 2 axillary lymph nodes. The goal of this study was to develop a nomogram predicting the probability of level 2 axillary lymph node metastasis (L-2-ALNM) in patients with level 1 axillary node-positive breast cancer.
Materials and Methods: We reviewed the records of 974 patients with pathology-confirmed level 1 node-positive breast cancer between 2010 and 2014 at the Liaoning Cancer Hospital and Institute. The patients were randomized 1:1 and divided into a modeling group and a validation group. Clinical and pathological features of the patients were assessed with uni- and multivariate logistic regression. A nomogram based on independent predictors for the L-2-ALNM identified by multivariate logistic regression was constructed.
Results: Independent predictors of L-2-ALNM by the multivariate logistic regression analysis included tumor size, Ki-67 status, histological grade, and number of positive level 1 axillary lymph nodes. The areas under the receiver operating characteristic curve of the modeling set and the validation set were 0.828 and 0.816, respectively. The false-negative rates of the L-2-ALNM nomogram were 1.82% and 7.41% for the predicted probability cut-off points of < 6% and < 10%, respectively, when applied to the validation group.
Conclusions: Our nomogram could help predict L-2-ALNM in patients with level 1 axillary lymph node metastasis. Patients with a low probability of L-2-ALNM could be spared level 2 axillary lymph node dissection, thereby reducing postoperative morbidity.
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