Impact of using intraoperative nomograms with one-step nucleic acid amplification to omit axillary lymph node dissection in patients with breast cancer who underwent mastectomy

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BACKGROUND: Omission of axillary lymph node dissection (ALND) in patients with positive sentinel lymph nodes (SLN) who underwent mastectomy remains controversial. In this study, we reported the omission of ALND in mastectomy cases with positive SLNs, using a nomogram to predict non-SLN metastasis. Furthermore, we reported the management of patients with more than four metastatic axillary lymph nodes (ALN). METHODS: We prospectively identified 392 patients with primary invasive breast cancer (cT1-3, N0) who underwent a mastectomy and were diagnosed with SLN metastasis using one-step nucleic acid amplification (OSNA). We used our predictive nomogram, including the OSNA factor for patients with positive SLNs, to make decisions regarding ALND and determine the probability of four or more axillary lymph node metastases. RESULTS: Of the 392 patients, 124 (31.3%) had one or two metastases to the SLNs, and 31 (25.0%) had a predictive probability of a nomogram for metastasis to non-SLNs (<13.0%) and did not undergo ALND. Only one patient experienced distant recurrence, and there were no cases of local recurrence during the median follow-up of 16.6 months (range 1-57). ALND was performed for all four patients with four or more ALN metastases, ensuring appropriate treatment when the cutoff value was increased to 20.0%. CONCLUSION: Our study indicated that our prediction model can accurately determine whether to omit ALND in patients who underwent mastectomy with one or two positive SLNs and are less likely to have four or more ALN metastases.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.