Original article: Predictors to assess non-sentinel lymph node status in breast cancer patients with only one sentinel lymph node metastasis

Abstract

Background The purpose of this study was to investigate the feasibility of avoiding axillary lymph node dissection (ALND) for patients with only one sentinel lymph node (SLN) metastasis. The characteristics and predictive factors for non-sentinel lymph node (NSLN) metastasis of patients with single positive SLN were also analyzed. Methods Patients with no and only one SLN metastasis (0/n and 1/n group, n ≥2) were selected from 1228 cases of invasive breast carcinoma, who underwent axillary dissection in Shandong Cancer Hospital between November 1999 and December 2011, to compare the characteristics of NSLN metastasis between them. For the 1/n group, the factors that influenced the NSLN metastasis were analyzed by univariate and multivariate analysis. Results Differences of the NSLN metastasis between the 0/n and the 1/n groups were significant (P <0.001). There was no significant difference between the axillary lymph node metastasis on level III in 1/n group and 0/n group (P=0.570). When the total SLN number was ≥4 and with one positive case, the NSLN metastasis was not significantly different from that in the 0/n group (P=0.118). In the 1/n group, clinical tumor size (P = 0.012), over-expression of Her-2 (P=0.003), tumor grade (P=0.018) and the total number of SLN (P=0.047) significantly correlated with non-SLN metastasis. Clinical tumor size (P=0.015) and the expression of Her-2 (P=0.01) were independent predictive factors for non-SLN metastasis by the Logistic regression model. Conclusion Under certain conditions, breast cancer patients with single SLN metastasis could avoid ALND.