A prospective validated model for predicting axillary node metastases based on 2,000 sentinel node procedures: The role of tumour location Journal Article
| Authors: | Bevilacqua, J. L. B.; Cody, H. S. 3rd; MacDonald, K. A.; Tan, L. K.; Borgen, P. I.; Van Zee, K. J. |
| Article Title: | A prospective validated model for predicting axillary node metastases based on 2,000 sentinel node procedures: The role of tumour location |
| Abstract: | Aims: The purpose was to identify the independent predictive factors of axillary lymph-node metastases (ALNM) in infiltrating ductal carcinoma (IFDC) and to create a prospective, validated statistical model to predict the likelihood of ALNM in patients in the present era of sentinel lymph-node (SLN) biopsy and enhanced histopathology. Methods: Univariate and multivariate analyses of 13 clinicopathological variables (including tumour location) were performed to determine predictors of ALNM in 1659 eligible SLN biopsy procedures. A logistic regression model was developed and then prospectively validated on a second population of 187 subsequent consecutive procedures. Results: Age, pathological tumour size, palpability, lymphovascular invasion (LVI), histological grade, nuclear grade, ductal histological subtype, tumour location (quadrant) and multifocality were associated with ALNM in univariate analyses (P < 0.001). Of these, only palpability and histological grade were not statistically associated with ALNM in the multivariate analysis (P > 0.05). The frequency of ALNM in upper-inner-quadrant (UIQ) tumours was 20.6%, compared with 33.2% for all other quadrants (P < 0.0005). There was no statistical difference between UIQ and other-quadrant tumours in any clinicopathological variables analysed. The logistic regression model, developed based on the population of 1659, had the same accuracy, sensitivity, specificity, positive predictive value and negative predictive value when applied prospectively to the second population. Conclusion: Tumour size, LVI, age, nuclear grade, histological subtype, multifocality and location in the breast were independent predictive factors for ALNM in IFDC. ALNM is less frequent in UIQ tumours than in other-quadrant tumours. Our prospectively validated predictive model could be valuable in pre-operative patient discussions, although staging of the axilla in the individual patient remains necessary. © 2002 Elsevier Science Ltd. All rights reserved. |
| Keywords: | adult; controlled study; human tissue; aged; middle aged; retrospective studies; major clinical study; histopathology; cancer patient; lymph node metastasis; lymph nodes; lymphatic metastasis; neoplasm staging; cancer grading; diagnostic accuracy; preoperative evaluation; prospective study; sensitivity and specificity; sentinel lymph node biopsy; disease association; tumor localization; mastectomy; tumor volume; breast neoplasms; prediction; age; cancer invasion; lymph vessel; axillary lymph node; population research; cancer infiltration; breast carcinoma; predictive value of tests; interpersonal communication; multivariate analysis; cancer classification; axilla; logistic regression analysis; statistical model; selection bias; palpation; predictors; carcinoma, ductal, breast; carcinoma, lobular; women's health; sentinel lymph nodes; tumor location; humans; human; female; priority journal; article; axillary lymph-node metastases; medial tumours |
| Journal Title: | European Journal of Surgical Oncology |
| Volume: | 28 |
| Issue: | 5 |
| ISSN: | 0748-7983 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2002-08-01 |
| Start Page: | 490 |
| End Page: | 500 |
| Language: | English |
| DOI: | 10.1053/ejso.2002.1268 |
| PUBMED: | 12217300 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 14 November 2014 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work