High Risk For Non-Sentinel Node Metastasis In Breast Cancer Patients With Sentinel Node Metastases

Background: To identify the risk factor of non-sentinel lymph node metastasis in breast cancer patients with sentinel lymph node metastasis in order to better guide the decision regarding axillary lymph node dissection (ALND) in breast cancer patients with 1-2 positive sentinel node metastases. Methods: A total of 215 patients with 1-2 positive sentinel lymph nodes (SLNs) who underwent ALND at Department of Breast at the Women's Hospital were reviewed. Independent clinicopathological factors predicting the non-SLN metastasis were analyzed using logistic regression analysis. A risk score was established to predict the non-SLN metastasis. Results: Multivariate logistic regression analysis revealed that increasing tumor size, presence of lymphovascular invasion, HER2 positivity were independent predictors of non-SLN metastasis. Besides, absent of negative SLNs was also an independent risk factor of non-SLN metastasis. Eighty-seven (40.5%) patients had non-SLN metastasis when 1-2 SLNs were positive. Thirty-three (15.3%) patients were classified as high risk of non-NSN metastasis according to the risk score, among which, there were 30 patients (90.9%) with non-SLN metastasis. Conclusion: ALND is beneficial in patients who met eligible for Z0011 criteria but at high risk of non-SLN involvement.