12P - Outcome analysis of patients with breast cancer and positive sentinel node

Date 07 May 2015
Event IMPAKT 2015
Session Welcome reception and Poster Walk
Topics Breast Cancer, Locally Advanced
Imaging, Diagnosis and Staging
Surgery and/or Radiotherapy of Cancer
Presenter Abdul Syed
Citation Annals of Oncology (2015) 26 (suppl_3): 4-5. 10.1093/annonc/mdv114
Authors A. Syed, S.R. Eleti, R. Buhain
  • Surgery, Southend University Hospital, SS00RY - Southend/UK

Abstract

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Introduction: Axillary lymph node dissection (ALND) still remains the standard of treatment for all breast cancer patients with positive Sentinel Lymph Node Biopsy (SLNB). However different strategies have evolved to challenge this approach to avoid the long term morbidity associated with this procedure. The ZOO 11 trial identified a group of low risk patients who can safely forego ALND and Memorial-Sloan Kettering Cancer Center (MSKCC) designed a prediction model (nomogram) to identify the risk of non-SLN metastases. Our aim was to analyse clinical and pathological outcomes of breast cancer patients who underwent ALND after positive SLNB and to assess the risk prediction of non-SLN metastases using the MSKCC prediction model.

Patients and methods: All operable breast cancer patients who underwent SLNB were identified between April 2009 and March 2013 and those who had positive SLNB and underwent ALND were considered eligible. Their tumour characteristics, recurrence rate and overall survival were analysed. Results from ALND were reviewed for non SLN metatases and the risk was calculated using online an MSKCC calculator and accuracy is determined by area under the receiver operating curve (AUC-ROC).

Results: Of the 918 patients who underwent SLNB, 55 women had nodal metastases with the SNB positivity rate of 6%. Of these, five patients were excluded (Four patients had neoadjuvant therapy before ALND and one patient declined surgery) and 50 patients were eligible for the study. Thirty one of these patients did not have any non SLN metastases (62%). At a median follow up of 37 months (range from 9 to 65 months), there were three deaths (two patients died of metastatic disease and one during chemotherapy). AUC-ROC achieved by the MSKCC nomogram when predicting the risk of non SLN metastases was 0.536 and statistically not significant (P value of 0.67).

Conclusions: This cohort of patients have excellent overall survival and regional control despite nodal metastases. The study demonstrates that more than half of these patients with SLN metatstases could be spared ALND. However it is difficult to identify this group as the MSKCC nomogram was unable to predict the risk accurately in our cohort of patients.

Disclosure: All authors have declared no conflicts of interest.