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    CLINICAL AND PATHOLOGIC FEATURES ASSOCIATED WITH REMOVAL OF FEWER THAN 10 LYMPH NODES IN AXILLARY LYMPH NODE DISSECTION FOR BREAST CANCER
    (Aves, 2011) Unal, Bulent; Polat, Ayfer Kamali; Andacoglu, Oya; Bonaventura, Marguerite; Gur, Serhat; Soran, Atilla
    Background: Current guidelines suggest that when performing axillary lymph node dissection for treatment of breast cancer, a minimum of 10 lymph nodes should be removed to allow for accurate pathologic staging to guide the treatment decision regarding the adjuvant treatment. The purpose of this study is to identify clinical and pathologic factors associated with retrieval of fewer than 10 lymph nodes in completion axillary lymph node dissection (CALND) performed for patients with breast cancer who had sentinel lymph node (SLN) metastasis. Materials and Methods: Patients with breast cancer who underwent SLN mapping and subsequent CALND at UPMC Magee-Womens Hospital were identified using the tumor registry database. Patients were divided into two groups according to the total number of nodes dissected. One group was comprised of patients in who had 10 or more lymph node dissection after SLN positivity while the other group comprised of the patients with fewer than 10 nodes dissected. We evaluated a number of clinical and pathological variables with their association with number of lymph nodes retrieved. These variables included patient age, timing of axillary surgery, neoadjuvant chemotherapy (NCT), tumor characteristics and SLN characteristics. Results: Three hundred seventy three patients underwent immediate or delayed completion level I-II axillary lymph node dissection after SLN biopsy demonstrated metastasis. The mean age of the patients was 53 (range 29-84) years. Fifty-four patients underwent NCT. Following SLN pathologic examination, immediate CALND was performed for 35.4% of patients and delayed CALND for 53.9% of all patients. By univariate analysis, following factors had significant association with dissection of fewer than 10 lymph nodes: NCT, tumor size, delayed CALND, and SLN micrometastases (p< 0.05). By multivariate analysis, NCT and SLN micrometastases were significantly associated with retrieval of fewer than 10 lymph nodes. Conclusion: In patients who have undergone CALND after identification of SLN metastasis, we found NCT and SLN micrometastases were associated with dissection of fewer than 10 axillary lymph nodes.
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    Validation of breast cancer nomograms for predicting the non sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi center study
    (European Journal of Surgical Oncology (EJSO), 2011) Gür, Akif Serhat; Ünal, Bülent; Özbek, Umut; Özmen, Vahit; Aydoğan, Fatih; Gökgöz, Mustafa Şehsuvar; Güllüoğlu, Mahmut Bahadır; Aksaz, Erol; Özbaş, Serdar; Başkan, Semih; Koyuncu, Ayhan; Soran, Atilla
    Objective: In the study, our aim was to evaluate the predictability of four different nomograms on non-sentinel lymph node metastases (NSLNM) in breast cancer (BC) patients with positive sentinel lymph node (SLN) biopsy in a multi-center study. Methods: We identified 607 patients who had a positive SLN biopsy and completion axillary lymph node dissection (CALND) at seven different BC treatment centers in Turkey. The BC nomograms developed by the Memorial Sloan Kettering Cancer Center (MSKCC), Tenon Hospital, Cambridge University, and Stanford University were used to calculate the probability of NSLNM. Area under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated for each nomogram and values greater than 0.70 were accepted as demonstrating good discrimination. Results: Two hundred and eighty-seven patients (287) of 607 patients (47.2%) had a positive axillary NSLNM. The AUC values were 0.705, 0.711, 0.730, and 0.582 for the MSKCC, Cambridge, Stanford, and Tenon models, respectively. On the multivariate analysis; overall metastasis size (OMS), lymphovascular invasion (LVI), and proportion of positive SLN to total SLN were found statistically significant. We created a formula to predict the NSLNM in our patient population and the AUC value of this formula was 0.8023. Conclusions: The MSKCC, Cambridge, and Stanford nomograms were good discriminators of NSLNM in SLN positive BC patients in this study. A newly created formula in this study needs to be validated in prospective studies in different patient populations. A nomogram to predict NSLNM in patients with positive SLN biopsy developed at one institution should be used with caution.