A Predictive Tool to Estimate the Risk of Axillary Metastases in Breast Cancer Patients with Negative Axillary Ultrasound

作者：Meretoja T J^*; Heikkila P S; Mansfield A S; Cserni G; Ambrozay E; Boross G; Zgajnar J; Perhavec A; Gazic B; Arisio R; Tvedskov T F; Jensen M B; Leidenius M H K

来源：Annals of Surgical Oncology, 2014, 21(7): 2229-2236.

DOI：10.1245/s10434-014-3617-6

Sentinel node biopsy (SNB) is the %26quot;gold standard%26quot; in axillary staging in clinically node-negative breast cancer patients. However, axillary treatment is undergoing a paradigm shift and studies are being conducted on whether SNB may be omitted in low-risk patients. The purpose of this study was to evaluate the risk factors for axillary metastases in breast cancer patients with negative preoperative axillary ultrasound. %26lt;br%26gt;A total of 1,395 consecutive patients with invasive breast cancer and SNB formed the original patient series. A univariate analysis was conducted to assess risk factors for axillary metastases. Binary logistic regression analysis was conducted to form a predictive model based on the risk factors. The predictive model was first validated internally in a patient series of 566 further patients and then externally in a patient series of 2,463 patients from four other centers. All statistical tests were two-sided. %26lt;br%26gt;A total of 426 of the 1,395 (30.5 %) patients in the original patient series had axillary lymph node metastases. Histological size (P %26lt; 0.001), multifocality (P %26lt; 0.001), lymphovascular invasion (P %26lt; 0.001), and palpability of the primary tumor (P %26lt; 0.001) were included in the predictive model. Internal validation of the model produced an area under the receiver operating characteristics curve (AUC) of 0.731 and external validation an AUC of 0.79. %26lt;br%26gt;We present a predictive model to assess the patient-specific probability of axillary lymph node metastases in patients with clinically node-negative breast cancer. The model performs well in internal and external validation. The model needs to be validated in each center before application to clinical use.

• 出版日期2014-7