Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize
Mercedes Herrero1, Raquel Ciérvide2, Maria Elisa Calle-Purón3
1Department of Gynecology and Obstetrics, HM Hospitales, Madrid 28050, Spain.
World Journal of Clinical Oncology
|September 13, 2021
Summary
A new Preoperative Clinical Risk Index (PCRI) helps identify breast cancer patients with positive sentinel lymph node biopsy (SLNB) who can safely avoid completion axillary lymph node dissection (cALND), reducing complications.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Management
Background:
- Sentinel lymph node biopsy (SLNB) is standard for clinically negative lymph nodes in breast cancer.
- The necessity of completion axillary lymph node dissection (cALND) after a positive SLNB remains debated.
- Identifying patients who can safely omit cALND is crucial to minimize long-term morbidity.
Purpose of the Study:
- To identify women with high axillary tumor burden eligible for SLNB where cALND can be omitted.
- To develop a Preoperative Clinical Risk Index (PCRI) for optimizing patient selection for cALND omission.
Main Methods:
- Retrospective analysis of patients with positive SLNB who underwent cALND.
- Univariate and multivariate analyses of prognostic factors to develop the PCRI.
- Evaluation of lymph-node tumor size and number of positive SLNs as key predictors.
Main Results:
- Of 125 positive SLNBs, 95 had macrometastasis.
- Multivariate analysis identified lymph-node tumor size (≤ 20 mm) and number of positive SLNs (> 1) as significant predictors for omitting cALND.
- The PCRI demonstrated varying probabilities of further nodal involvement based on score (≤15: <10%; 15-17.6: 43%; >17.6: 69%).
Conclusions:
- The PCRI is a promising tool for estimating nodal involvement risk post-SLNB.
- It aids in identifying patients who may safely omit cALND, potentially reducing complications.
- Further prospective studies are needed to validate the PCRI for broader clinical application.
