Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

Mercedes Herrero; Raquel Ciérvide; Maria Elisa Calle-Purón; Javier Valero; Paula Buelga; Isabel Rodriguez-Bertos; Leticia Benassi; Angel Montero

doi:10.5306/wjco.v12.i8.675

Macrometastasis at selective lymph node biopsy: A practical going-for-the-one clinical scoring system to personalize decision making

World J Clin Oncol. 2021 Aug 24;12(8):675-687. doi: 10.5306/wjco.v12.i8.675.

Authors

Mercedes Herrero¹, Raquel Ciérvide², Maria Elisa Calle-Purón³, Javier Valero¹, Paula Buelga¹, Isabel Rodriguez-Bertos¹, Leticia Benassi¹, Angel Montero⁴

Affiliations

¹ Department of Gynecology and Obstetrics, HM Hospitales, Madrid 28050, Spain.
² Department of Radiation Oncology, HM Hospitales, Madrid 28050, Spain. raquel.ciervide@gmail.com.
³ Department of Preventive Medicine and Public Health, Complutense University of Madrid, Madrid 28050, Spain.
⁴ Department of Radiation Oncology, HM Hospitales, Madrid 28050, Spain.

Abstract

Background: Axillary sentinel lymph node biopsy (SLNB) is standard treatment for patients with clinically and pathological negative lymph nodes. However, the role of completion axillary lymph node dissection (cALND) following positive sentinel lymph node biopsy (SLNB) is debated.

Aim: To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of long-term complications and create a Preoperative Clinical Risk Index (PCRI) that helps us in our clinical practice to optimize the selection of these patients.

Methods: Patients with positive SLNB who underwent a cALND were included in this study. Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND.

Results: From May 2007 to April 2014, we performed 1140 SLN biopsies, of which 125 were positive for tumor and justified to practice a posterior cALND. Pathologic findings at SLNB were micrometastases (mic) in 29 cases (23.4%) and macrometastasis (MAC) in 95 cases (76.6%). On univariate analysis of the 95 patients with MAC, statistically significant factors included: age, grade, phenotype, histology, lymphovascular invasion, lymph-node tumor size, and number of positive SLN. On multivariate analysis, only lymph-node tumor size (≤ 20 mm) and number of positive SLN (> 1) retained significance. A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND. Patients with a PCRI ≤ 15 has low probability (< 10%) of having additional lymph node involvement, a PRCI between 15-17.6 has a probability of 43%, and the probability increases to 69% in patients with a PCRI > 17.6.

Conclusion: The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND. Further prospective studies are necessary to validate PCRI clinical generalization.

Keywords: Complete axillary lymph node dissection; Macrometastasis; Preoperative clinical risk index; Sentinel lymph node biopsy.