Toward Exempting from Sentinel Lymph Node Biopsy in T1 Breast Cancer Patients: A Retrospective Study

Guozheng Li; Jiyun Zhao; Xingda Zhang; Xin Ma; Hui Li; Yihai Chen; Lei Zhang; Xin Zhang; Jiale Wu; Xinheng Wang; Yan Zhang; Shouping Xu

doi:10.3389/fsurg.2022.890554

Toward Exempting from Sentinel Lymph Node Biopsy in T1 Breast Cancer Patients: A Retrospective Study

Front Surg. 2022 Jun 28:9:890554. doi: 10.3389/fsurg.2022.890554. eCollection 2022.

Authors

Guozheng Li¹, Jiyun Zhao², Xingda Zhang¹, Xin Ma¹, Hui Li¹, Yihai Chen¹, Lei Zhang¹, Xin Zhang¹, Jiale Wu¹, Xinheng Wang¹, Yan Zhang², Shouping Xu¹

Affiliations

¹ Department ofs Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
² School of Life Science and Technology, Computational Biology Research Center, Harbin Institute of Technology, Harbin, China.

Abstract

Background and objective: Sentinel lymph node biopsy (SLNB) is used to assess the status of axillary lymph node (ALN), but it causes many adverse reactions. Considering the low rate of sentinel lymph node (SLN) metastasis in T1 breast cancer, this study aims to identify the characteristics of T1 breast cancer without SLN metastasis and to select T1 breast cancer patients who avoid SLNB through constructing a nomogram.

Methods: A total of 1,619 T1 breast cancer patients with SLNB in our hospital were enrolled in this study. Through univariate and multivariate logistic regression analysis, we analyzed the tumor anatomical and clinicopathological factors and constructed the Heilongjiang Medical University (HMU) nomogram. We selected the patients exempt from SLNB by using the nomogram.

Results: In the training cohort of 1,000 cases, the SLN metastasis rate was 23.8%. Tumor volume, swollen axillary lymph nodes, pathological types, and molecular subtypes were found to be independent predictors for SLN metastasis in multivariate regression analysis. Distance from nipple or surface and position of tumor have no effect on SLN metastasis. A regression model based on the results of the multivariate analysis was developed to predict the risk of SLN metastasis, indicating an AUC of 0.798. It showed excellent diagnostic performance (AUC = 0.773) in the validation cohort.

Conclusion: The HMU nomogram for predicting SLN metastasis incorporates four variables, including tumor volume, swollen axillary lymph nodes, pathological types, and molecular subtypes. The SLN metastasis rates of intraductal carcinoma and HER2 enriched are 2.05% and 6.67%. These patients could be included in trials investigating the SLNB exemption.

Keywords: SLNB; T1 breast cancer; axillary surgery; exempting; molecular subtypes.