POZİTİF SENTİNEL LENF DÜĞÜMÜ OLAN MEME KANSERLİ HASTALARDA TAMAMLAYICI AKSİLLER DİSEKSIYON GEREKLİLİĞİNİN NOMOGRAM YÖNTEMLERİNİN DEĞERLENDİRİLMESİYLE BELİRLENMESİ

AMAÇ: Amacımız meme kanseri nedeniyle ameliyat edilen hastalarda farklı nomogram yaklaşımları olan Memorial Sloan Kettering Kanser Merkezi (MSKCC), Stanford Üniversitesi, Tenon Hastanesi, Cambridge Üniversitesi ve TR yöntemlerininin etkinliklerini değerlendirmekti. YÖNTEM: Araştırmaya Ankara Numune Eğitim ve Araştırma Hastanesi A2 Genel Cerrahi Kliniği'nde 2007-2012 yılları arasında meme kanseri nedeniyle ameliyat olan 60 meme kanserli hasta dahil edildi. Tüm hastalar sentinel lenf nodu (SLN) pozitifti ve aksiller lenf nodu diseksiyonu (ALND) geçirmişti. Bu 60 hastaya retrospektif olarak beş farklı skorlama sistemi uygulandı. Nomogramlar için receiver operating characteristics (ROC) eğrileri oluşturulmuş ve eğri altında kalan alan (AUC), duyarlılık ve özgüllük sonuçları hesaplanmıştır. BULGULAR: Yirmi iki hastada (%37) aksiller SLN dışı metastaz vardı. MSKCC, Stanford, Cambridge, Tenon ve TR nomogramlarının AUC değerleri sırasıyla 0.646, 0.644, 0.62, 0.595 ve 0.660 olarak hesaplandı. SLN metastazı boyutu açısından SLN metastazı olan ve olmayan gruplar arasında anlamlı fark bulundu (p = 0.013). SONUÇ: MSKCC, Stanford, Cambridge, Tenon ve TR nomogram modellerinin, SLN pozitif meme kanserli hastalarda SLN dışı metastazları olan ve olmayan hastaları ayırt etmek için yetersiz güce sahip olduğu bulundu (AUC değerleri

Anahtar Kelimeler:

Meme kanseri, Sentinel lenf nodu, Sentinel olmayan lenf nodu, Nomogram

DETERMINING THE NECESSITY OF COMPLEMENTARY AXILLARY DISSECTION IN BREAST CANCER PATIENTS WITH POSITIVE SENTINEL LYMPH NODE BY WAY OF ASSESSING NOMOGRAM METHODS

AIM: Our aim was to evaluate the efficacies of different nomogram approaches, including the Memorial Sloan Kettering Cancer Centre (MSKCC), Stanford University, Tenon Hospital, Cambridge University and TR methods, in patients operated for breast cancer. MATERIAL AND METHOD: The study included 60 breast cancer patients who were operated on for breast cancer at Ankara Numune Training and Research Hospital, A2 General Surgery Clinic, between 2007 and 2012. All patients were sentinel lymph node (SLN)-positive and had undergone axillary lymph node dissection (ALND). Five different scoring systems were applied retrospectively to these 60 patients. Receiver operating characteristics (ROC) curves were created for the nomograms and the area under the curve (AUC) sensitivity and specificity results were calculated. RESULTS: Twenty-two patients (37%) had axillary non-SLN metastases. AUC values of MSKCC, Stanford, Cambridge, Tenon and TR nomogram were calculated as 0.646, 0.644, 0.62, 0.595, and 0.66, respectively. A significant difference was found between the groups with and without non-SLN metastasis in terms of SLN metastasis size (p = 0.013). CONCLUSION: The MSKCC, Stanford, Cambridge, Tenon, and TR nomogram models were found to have insufficient power to discriminate between patients with and without non-SLN metastases in patients with SLN-positive breast cancer (AUC values

Keywords:

Breast cancer, Sentinel lymph node, Non-sentinel lymph node, Nomogram,

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1) Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71: 209-49.
2) Özbalcı GS, Özbalcı AB, Tuncal S. Meme koruyucu cerrahi sonrası lokal nüks. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2016; 49: 46-54.
3) Ozkazanc Kulduk G. Meme Koruyucu Cerrahi Ve Sentinel Lenf Nodu Biyopsi Materyallerinin İntraoperatif Patolojik Değerlendirilmesi. In: Gül VO, Şahin M, Babayiğit M, et al., editors. Peroperatif Hasta Yöntemi. Ankara: Berikan Yayınevi; 2021. p. 141-8.
4) Anderson BO, Austin-Seymour MM, Gralow JR, et al. A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer. Cancer Control. 1997; 4: 491-9.
5) Weaver DL, Krag DN, Ashikaga T, et al. Pathologic analysis of sentinel and nonsentinel lymph nodes in breast carcinoma: a multicenter study. Cancer. 2000; 88: 1099-107.
6) Schrenk P, Rieger R, Shamiyeh A, et al. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer. 2000; 88: 608-14.
7) Valero MG, Muhsen S, Moo TA, et al. Increase in Utilization of Nipple-Sparing Mastectomy for Breast Cancer: Indications, Complications, and Oncologic Outcomes. Ann Surg Oncol. 2020; 27: 344-51.
8) Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010; 252: 426-32; discussion 32-3.
9) Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003; 349: 546-53.
10) Center MSKC. Breast Cancer Nomogram: Breast Additional Non SLN Metastases. 2021; Available at: http://nomograms.mskcc.org/Breast/BreastAdditionalNonSLNMetastasesPage.aspx. Access date: 20.03.2021.
11) tools P. 2021; Available at: http://www3-hrpdcc.stanford.edu/nsln-calculator.
12) Barranger E, Coutant C, Flahault A, et al. An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement. Breast Cancer Res Treat. 2005; 91: 113-9.
13) Pal A, Provenzano E, Duffy SW, et al. A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive. Br J Surg. 2008; 95: 302-9.
14) Gur AS, Unal B, Ozbek U, et al. Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study. Eur J Surg Oncol. 2010; 36: 30-5.
15) Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018; 19: 1385-93.
16) Sávolt Á, Péley G, Polgár C, et al. Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla - Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: A randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017; 43: 672-9.
17) Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002; 347: 567-75.
18) Veronesi U, Marubini E, Mariani L, et al. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer. 1999; 35: 1320-5.
19) Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol. 2003; 10: 1140-51.
20) Kohrt HE, Olshen RA, Bermas HR, et al. New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients. BMC Cancer. 2008; 8: 66.
21) Park J, Fey JV, Naik AM, et al. A declining rate of completion axillary dissection in sentinel lymph node-positive breast cancer patients is associated with the use of a multivariate nomogram. Ann Surg. 2007; 245: 462-8.
22) Unal B, Gur AS, Ahrendt G, et al. Can nomograms predict non-sentinel lymph node metastasis after neoadjuvant chemotherapy in sentinel lymph node-positive breast cancer patients? Clin Breast Cancer. 2009; 9: 92-5.
23) Sasada T, Murakami S, Kataoka T, et al. Memorial Sloan-Kettering Cancer Center Nomogram to predict the risk of non-sentinel lymph node metastasis in Japanese breast cancer patients. Surg Today. 2012; 42: 245-9.
24) Degnim AC, Reynolds C, Pantvaidya G, et al. Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram. Am J Surg. 2005; 190: 543-50.
25) Klar M, Foeldi M, Markert S, et al. Good prediction of the likelihood for sentinel lymph node metastasis by using the MSKCC nomogram in a German breast cancer population. Ann Surg Oncol. 2009; 16: 1136-42.
26) Smidt ML, Kuster DM, van der Wilt GJ, et al. Can the Memorial Sloan-Kettering Cancer Center nomogram predict the likelihood of nonsentinel lymph node metastases in breast cancer patients in the Netherlands? Ann Surg Oncol. 2005; 12: 1066-72.
27) Andersson Y, Frisell J, de Boniface J, et al. Prediction of non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastases: evaluation of the tenon score. Breast Cancer (Auckl). 2012; 6: 31-8.
28) Gur AS, Unal B, Johnson R, et al. Predictive probability of four different breast cancer nomograms for nonsentinel axillary lymph node metastasis in positive sentinel node biopsy. J Am Coll Surg. 2009; 208: 229-35.
29) Reynolds C, Mick R, Donohue JH, et al. Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? J Clin Oncol. 1999; 17: 1720-6.
30) Unal B, Gur AS, Kayiran O, et al. Models for predicting non-sentinel lymph node positivity in sentinel node positive breast cancer: the importance of scoring system. Int J Clin Pract. 2008; 62: 1785-91.
31) Meretoja TJ, Leidenius MH, Heikkilä PS, et al. International multicenter tool to predict the risk of nonsentinel node metastases in breast cancer. J Natl Cancer Inst. 2012; 104: 1888-96.
32) Mittendorf EA, Hunt KK, Boughey JC, et al. Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node. Ann Surg. 2012; 255: 109-15.
33) Dingemans SA, de Rooij PD, van der Vuurst de Vries RM, et al. Validation of Six Nomograms for Predicting Non-sentinel Lymph Node Metastases in a Dutch Breast Cancer Population. Ann Surg Oncol. 2016; 23: 477-81.