Development of a predictive score of axillary lymph node dissection based on targeted axillary dissection in patients with breast cancer diagnosis, affected lymph nodes, and neoadjuvant treatment
| Autor: | Luis Carrasco-González, Andrés Nieto-Olivares, María Martínez-Gálvez, José Ignacio Gil-Izquierdo, Francisco Ayala de la Peña, José Luis Aguayo-Albasini, María José Ibáñez-Ibáñez, José Aguilar-Jiménez, Diego Flores-Funes, María Asunción Chaves-Benito |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Youden's J statistic Breast Neoplasms Logistic regression 03 medical and health sciences 0302 clinical medicine Breast cancer Biopsy Antineoplastic Combined Chemotherapy Protocols medicine Humans 030212 general & internal medicine Prospective Studies Neoadjuvant therapy Univariate analysis medicine.diagnostic_test business.industry Axillary Lymph Node Dissection Odds ratio Middle Aged medicine.disease Prognosis Combined Modality Therapy Neoadjuvant Therapy Oncology 030220 oncology & carcinogenesis Case-Control Studies Axilla Lymph Node Excision Surgery Female Radiology Lymph Nodes business Follow-Up Studies |
| Zdroj: | Surgical oncology. 38 |
| ISSN: | 1879-3320 |
| Popis: | Aim To determine predictive factors of axillary lymph node dissection (ALND) results in breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NACT), and subsequent staging using Targeted Axillary Dissection (TAD). Material and method Case-control study between January 2016 and August 2019. Patients with BC, cN1 staging, marked with a metallic clip prior to NACT, and subsequently staged with TAD and ALND were included. They were divided into 2 groups: ALND patients with or without metastatic involvement (group 1 and group 2, respectively). We carried out a univariate analysis comparing clinical, radiological, surgical and pathological variables, and a logistic regression, (dependent variable: positive result of ALND; independent variables: number of suspicious lymph nodes in diagnostic ultrasound, positive hormone receptors, HER2 positive, complete clinical-radiological response to NACT, positive TAD, and biopsy of ≤2 nodes in TAD). A score for prediction of a metastatic ALND was proposed, with an internal validation study. Results 60 patients were included: Group 1: 33 (55.0%); Group 2: 27 (45.0%). Tumor size (Odds Ratio (OR) = 1.67; 95%CI 1.02–2.74), number of suspected nodes in ultrasound (OR = 2.20; 95%CI 1.01–4, 77), HER2 positive (OR 0.04; 95%CI 0.003–0.54), clinical-radiological response to NACT (OR = 0.07; 95%CI 0.01–0.75), and positive TAD (OR 15.48; 95%CI 1.68–142.78) were independent predictors of a positive result in ALND. We developed a “positive ALND predictive score”, with good calibration (Hosmer-Lemeshow test: p = 0.65), and discrimination (AUC = 0.93; 95% CI 0, 87–0.99), with highest Youden index (0.7) at cut-off point of 17% risk of positive ALND (sensitivity = 100%; specificity = 70%). Conclusion Tumor size, number of suspected nodes, positive HER2, response to NACT, and metastatic TAD are independent predictors of ALND. The predictive score for positive ALND would be a good indicator to safely omit ALND. |
| Databáze: | OpenAIRE |
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