Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Amina Maimaitiaili, Di Wu, Zhenyu Liu, Haimeng Liu, Xiamusiye Muyiduli, Zhimin Fan


Objective: Axillary lymph node dissection (ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymphnode (NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stagebreast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.

Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegativeand had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathologicalcharacteristics of patients with positive NSLN metastasis who underwent ALND were investigated.

Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases wereconfirmed in 95 patients (32.1%). On univariate analysis, ≥ 3 positive NSLN metastases (P <0.01), NSLN macrometastases (P =0.023), and lymphovascular invasion (P = 0.04) were associated with non-NSLN metastasis (P <0.05). In multivariate analysis, thenumber of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated riskfactors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.

Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with non-SLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factorswere present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons OncologyGroup Z0011 trial (27.3%); thus, avoiding ALND should be considered carefully.


Breast cancer; sentinel lymph node metastasis; axillary lymph node dissection; non-sentinel lymph node metastasis

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