<p>Intraoperative Prediction Of Non-Sentinel Lymph Node Metastasis Based On The Molecular Assay In Breast Cancer Patients</p>

Abstract

PurposeThe aim of the study is to construct an intraoperative nomogram for the prediction of non-sentinel lymph node (NSLN) metastasis based on the one-step nucleic acid amplification assay in breast cancer patients.MethodsA total of 552 patients were enrolled in the training study and 1090 patients were enrolled in the validation study. The nomogram was constructed based on the molecular assay with logistic multivariate regression analysis in the training study and was validated in the validation study.ResultsA novel nomogram model was constructed with the total tumor load, the clinical primary tumor size, the number of positive and negative sentinel lymph nodes. The area under the receiver operating characteristic curve (AUC) of the model was 0.842. The AUC of the model which was sensitive to discern the patients with the stage of pN1 and ≥pN2 was 0.861.ConclusionThe nomogram model will help to guide the axillary management intraoperatively and precisely confirm the target region of radiotherapy postoperatively.

Predictive and prognostic value of total tumor load in sentinel lymph nodes in breast cancer patients after neoadjuvant treatment using one-step nucleic acid amplification: the NEOVATTL study

“…The nomogram for prediction of non-SLN metastasis incorporated three parameters: TTL, tumor size, and a twocomponent histopathologic variable (HER2-negative tumor plus Ki67 of ≤ 20%). TTL and tumor size are parameters common to nomograms predicting non-SLN metastasis developed by other investigators [24][25][26]. For example, Shimazu and colleagues' intraoperative nomogram included TTL (log TTL) and tumor size (non-binary) as predictive variables [25].…”

“…While the ACOSOG Z001 trial demonstrated that ALND can be avoided in a select group of SLN-positive patients [ 27 ], patients who have received NST such as those in our study do not meet ACOSOG Z001 criteria, and indeed application of these criteria seems to exclude the majority of SLN-positive patients [ 25 ]. Since an OSNA assay to determine TTL and thus non-SLN involvement can be performed intraoperatively [ 25 , 26 ], it can also offer the advantage of clinical decision-making during primary surgery, avoiding a second surgery for ALND if required.…”