Sentinel Lymph Node Biopsy Predicts Non-Sentinel Lymph Node Metastases and Supports Omission of Axillary Lymph Node Dissection in Breast Cancer Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Characteristics
2.2. Histopathological Assessment
2.3. Assessment by OSNA
2.4. Prediction by Shimazu’s Nomogram
2.5. Statistical Analysis
3. Results
3.1. A Considerable Number of SLN-Positive Cases May Not Require ALND and OSNA Detection May Be an Overdiagnosis
3.2. Importance of SLNB in Axillary Management
3.3. Correlation of NSLN Metastasis Status with Tumor Characteristics
3.4. Prediction of NSLN Metastatic Status from Tumor Characteristics Using Shimazu’s Nomograms
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ALND | Axillary lymph node dissection |
CT | Computed tomography |
cN (−) | Clinically node negative |
ER | Estrogen receptor |
HER2 | Human epidermal growth factor receptor type 2 |
ITC | Isolated tumor cell |
NAC | Neoadjuvant chemotherapy |
NSLN | Non-sentinel lymph node |
OSNA | One-step nucleic acid amplification |
pN (+) | Pathologically positive lymph node |
PgR | Progesterone receptor |
SLN | Sentinel lymph node |
SLNB | Sentinel lymph node biopsy |
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Characteristics | Histological Method | OSNA Method | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
SLNB (+) | SLNB (+) | SLN (+) Micro- Metastasis | SLN (+) ALND- Performed | NAC (−) Metastasis (−) | |||||||
Period | July 2006 ~ March 2012 | April 2012 ~ December 2014 | April 2012 ~ December 2014 | April 2012 ~ December 2016 | April 2012 ~ December 2019 | ||||||
Total patient number | n = 463 | n = 181 | n = 21 | n = 69 | n = 581 | ||||||
Age (Mean ± SD) | 61.6 ± 12.7 | 62.2 ± 13.9 | 64.5 ± 12.3 | 62.0 ± 14.0 | 63.2 ± 13.0 | ||||||
Patient number, n, and % | n | % | n | % | n | % | n | % | n | % | |
Gender | Male | 4 | 0.9 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0.2 |
Female | 459 | 99.1 | 181 | 100 | 21 | 100 | 69 | 100 | 580 | 99.8 | |
Tumor stage | Tis | 40 | 8.6 | 15 | 8.3 | 0 | 0 | 1 | 1.4 | 65 | 11.2 |
T1 | 270 | 58.3 | 117 | 64.6 | 11 | 52.4 | 42 | 60.9 | 392 | 67.5 | |
T2 | 131 | 28.3 | 44 | 24.3 | 9 | 42.9 | 23 | 33.3 | 111 | 19.1 | |
T3 | 10 | 2.2 | 3 | 1.7 | 1 | 4.8 | 3 | 4.3 | 16 | 2.8 | |
T4 | 9 | 1.9 | 1 | 0.6 | 0 | 0 | 0 | 0 | 1 | 0.2 | |
Missing data | 3 | 0.6 | 1 | 0.6 | 0 | 0 | 0 | 0 | 6 | 1.0 | |
Nottingham histologic grade | Grade 1 | 173 | 37.4 | 83 | 45.9 | 10 | 47.6 | 43 | 62.3 | 377 | 64.9 |
Grade 2 | 104 | 22.5 | 48 | 26.5 | 6 | 28.6 | 11 | 15.9 | 100 | 17.2 | |
Grade 3 | 145 | 31.3 | 47 | 26.0 | 5 | 23.8 | 15 | 21.7 | 95 | 16.4 | |
Missing data | 41 | 8.9 | 3 | 1.7 | 0 | 0 | 0 | 0 | 9 | 1.5 | |
Tumor subtype | ER (+), HER2 (−) | 242 | 52.3 | 84 | 46.4 | 11 | 52.4 | 29 | 42.0 | 165 | 28.4 |
ER (+), HER2 (+) | 129 | 27.9 | 67 | 37.0 | 7 | 33.3 | 33 | 47.8 | 325 | 55.9 | |
ER (−), HER2 (+) | 49 | 10.6 | 18 | 9.9 | 2 | 9.5 | 6 | 8.7 | 62 | 10.7 | |
ER (−), HER2 (−) | 33 | 7.1 | 11 | 6.1 | 1 | 4.8 | 1 | 1.4 | 29 | 5.0 | |
Missing data | 10 | 2.2 | 1 | 0.6 | 0 | 0 | 0 | 0 | 0 | 0 | |
Type of breast surgery | Mastectomy | 192 | 41.5 | 95 | 52.5 | 14 | 66.7 | 52 | 75.4 | 363 | 62.5 |
Breast-conserving surgery | 271 | 58.5 | 86 | 47.5 | 7 | 33.3 | 17 | 24.6 | 218 | 37.5 |
Characteristics | n | p-Value | ||
---|---|---|---|---|
NSLN | ||||
(+) | (−) | |||
ER | (+) | 2 | 16 | 0.546 |
(−) | 1 | 2 | ||
PgR | (+) | 1 | 12 | 0.366 |
(−) | 2 | 6 | ||
HER2 | (+) | 1 | 3 | 0.651 |
(−) | 2 | 15 | ||
Nuclear grade | 1 | 1 | 9 | 0.291 |
2 | 0 | 6 | ||
3 | 2 | 3 | ||
Ki-67 | 10% | 2 | 10 | 0.651 |
10~30% | 1 | 5 | ||
30% | 0 | 3 | ||
Subtype | Luminal A | 1 | 12 | 0.615 |
Luminal B | 2 | 2 | ||
Luminal B/HER2 | 0 | 2 | ||
HER2 | 0 | 1 | ||
Triple negative | 0 | 1 | ||
Tumor size | 1 | 0 | 11 | 0.044 * |
2 | 2 | 7 | ||
3 | 1 | 0 | ||
Histological type | Tubular | 0 | 9 | 0.159 |
Solid | 1 | 3 | ||
Scirrhous | 1 | 4 | ||
Others | 1 | 1 | ||
Age | <50 | 0 | 2 | 0.315 |
50~70 | 1 | 12 | ||
>70 | 2 | 4 | ||
Lymphatic invasion | (+) | 3 | 12 | 0.366 |
(−) | 0 | 6 | ||
Vascular invasion | (+) | 3 | 5 | 0.050 |
(−) | 0 | 13 | ||
Total tumor load | <1000 | 1 | 11 | 0.580 |
1000~2500 | 2 | 5 | ||
2500~5000 | 0 | 2 |
Characteristics | n | p-Value | ||
---|---|---|---|---|
NSLN | ||||
(+) | (−) | |||
ER | (+) | 18 | 43 | 0.472 |
(−) | 3 | 4 | ||
PgR | (+) | 15 | 34 | 0.991 |
(−) | 4 | 9 | ||
HER2 | (+) | 4 | 6 | 0.472 |
(−) | 16 | 40 | ||
Vascular invasion | (+) | 7 | 10 | 0.373 |
(−) | 15 | 36 | ||
Lymphatic invasion | (+) | 15 | 23 | 0.189 |
(−) | 7 | 22 | ||
Nuclear grade | 1 | 10 | 32 | 0.093 |
2 | 4 | 7 | ||
3 | 7 | 8 | ||
Ki-67 | 10% | 7 | 17 | 0.629 |
10%~30% | 8 | 20 | ||
30% | 6 | 10 | ||
Tumor size | is | 0 | 1 | 0.069 |
1 | 11 | 31 | ||
2 | 8 | 15 | ||
3 | 3 | 0 | ||
Maximum copy number of metastatic SLN (cps/µL) | <1 × 104 | 6 | 28 | 0.002 ** |
~2 × 104 | 1 | 5 | ||
~4 × 104 | 2 | 3 | ||
~10 × 104 | 3 | 5 | ||
>10 × 104 | 10 | 6 | ||
Total tumor load | <1 × 104 | 6 | 26 | 0.004 ** |
~2 × 104 | 1 | 5 | ||
~4 × 104 | 2 | 5 | ||
~10 × 104 | 3 | 5 | ||
>10 × 104 | 10 | 6 | ||
SLN metastasis | Micro | 4 | 21 | 0.034 * |
Macro | 18 | 26 |
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Yoneto, T.; Ikiuo, F.; Koyanagi, N.; Yoshimoto, T.; Takeda, Y. Sentinel Lymph Node Biopsy Predicts Non-Sentinel Lymph Node Metastases and Supports Omission of Axillary Lymph Node Dissection in Breast Cancer Patients. J. Clin. Med. 2025, 14, 3441. https://doi.org/10.3390/jcm14103441
Yoneto T, Ikiuo F, Koyanagi N, Yoshimoto T, Takeda Y. Sentinel Lymph Node Biopsy Predicts Non-Sentinel Lymph Node Metastases and Supports Omission of Axillary Lymph Node Dissection in Breast Cancer Patients. Journal of Clinical Medicine. 2025; 14(10):3441. https://doi.org/10.3390/jcm14103441
Chicago/Turabian StyleYoneto, Toshihiko, Fumiko Ikiuo, Naoko Koyanagi, Takayuki Yoshimoto, and Yasutaka Takeda. 2025. "Sentinel Lymph Node Biopsy Predicts Non-Sentinel Lymph Node Metastases and Supports Omission of Axillary Lymph Node Dissection in Breast Cancer Patients" Journal of Clinical Medicine 14, no. 10: 3441. https://doi.org/10.3390/jcm14103441
APA StyleYoneto, T., Ikiuo, F., Koyanagi, N., Yoshimoto, T., & Takeda, Y. (2025). Sentinel Lymph Node Biopsy Predicts Non-Sentinel Lymph Node Metastases and Supports Omission of Axillary Lymph Node Dissection in Breast Cancer Patients. Journal of Clinical Medicine, 14(10), 3441. https://doi.org/10.3390/jcm14103441