Meretoja T J, Heikkilä P S, Mansfield A S, Cserni G, Ambrozay E, Boross G, Zgajnar J, Perhavec A, Gazic B, Arisio R, Tvedskov T F, Jensen M-B, Leidenius M H K
Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland,
Ann Surg Oncol. 2014 Jul;21(7):2229-36. doi: 10.1245/s10434-014-3617-6. Epub 2014 Mar 25.
Sentinel node biopsy (SNB) is the "gold standard" in axillary staging in clinically node-negative breast cancer patients. However, axillary treatment is undergoing a paradigm shift and studies are being conducted on whether SNB may be omitted in low-risk patients. The purpose of this study was to evaluate the risk factors for axillary metastases in breast cancer patients with negative preoperative axillary ultrasound.
A total of 1,395 consecutive patients with invasive breast cancer and SNB formed the original patient series. A univariate analysis was conducted to assess risk factors for axillary metastases. Binary logistic regression analysis was conducted to form a predictive model based on the risk factors. The predictive model was first validated internally in a patient series of 566 further patients and then externally in a patient series of 2,463 patients from four other centers. All statistical tests were two-sided.
A total of 426 of the 1,395 (30.5 %) patients in the original patient series had axillary lymph node metastases. Histological size (P < 0.001), multifocality (P < 0.001), lymphovascular invasion (P < 0.001), and palpability of the primary tumor (P < 0.001) were included in the predictive model. Internal validation of the model produced an area under the receiver operating characteristics curve (AUC) of 0.731 and external validation an AUC of 0.79.
We present a predictive model to assess the patient-specific probability of axillary lymph node metastases in patients with clinically node-negative breast cancer. The model performs well in internal and external validation. The model needs to be validated in each center before application to clinical use.
前哨淋巴结活检（SNB）是临床腋窝淋巴结阴性乳腺癌患者腋窝分期的“金标准”。然而，腋窝治疗正在经历模式转变，目前正在研究低风险患者是否可省略SNB。本研究的目的是评估术前腋窝超声阴性的乳腺癌患者腋窝转移的危险因素。
共有1395例连续性浸润性乳腺癌患者及SNB构成原始患者系列。进行单因素分析以评估腋窝转移的危险因素。进行二元逻辑回归分析以基于危险因素形成预测模型。该预测模型首先在566例其他患者的患者系列中进行内部验证，然后在来自其他四个中心的2463例患者的患者系列中进行外部验证。所有统计检验均为双侧检验。
原始患者系列中的1395例患者中有426例（30.5%）发生腋窝淋巴结转移。预测模型纳入了组织学大小（P<0.001）、多灶性（P<0.001）、淋巴管浸润（P<0.001）和原发肿瘤的可触及性（P<0.001）。该模型的内部验证产生的受试者工作特征曲线下面积（AUC）为0.731，外部验证的AUC为0.79。
我们提出了一种预测模型，以评估临床腋窝淋巴结阴性乳腺癌患者腋窝淋巴结转移的个体特异性概率。该模型在内部和外部验证中表现良好。在应用于临床之前，该模型需要在每个中心进行验证。
