Clinical Report: Nomogram for Forecasting Lymph Node Metastasis in Breast Cancer
Overview
This study developed a nomogram to predict lymph node metastasis in breast cancer patients undergoing axillary reverse mapping (ARM). The nomogram demonstrated excellent discrimination in a development cohort and acceptable discrimination in a validation cohort, identifying several independent predictors of metastasis.
Background
Breast cancer is the most commonly diagnosed malignancy and poses significant risks of complications such as lymphedema following surgery. Axillary reverse mapping (ARM) is a technique aimed at preserving lymphatic drainage during surgery, but concerns about the metastatic potential of ARM lymph nodes necessitate reliable predictive tools. Understanding the risk factors for ARM lymph node metastasis is crucial.
Data Highlights
Parameter
Value
Patients in Development Cohort
142
Patients with Metastasis
33 (23.24%)
AUC Development Cohort
0.934
AUC Validation Cohort
0.826
Key Findings
ARM lymph nodes were identified in 92.81% of patients.
Metastasis occurred in 23.24% of ARM lymph nodes.
Independent predictors of metastasis included menarche age ≤ 12 years, elevated fibrinogen, elevated CA15-3, elevated platelet-to-lymphocyte ratio, presence of sentinel ARM lymph nodes, larger ARM lymph node long diameter, and ultrasound-detected axillary abnormalities.
The nomogram showed excellent discrimination in the development cohort (AUC = 0.934) and acceptable discrimination in the validation cohort (AUC = 0.826).
Four lymphatic drainage patterns were defined based on ARM-sentinel lymph node distance and shared trunks.
Clinical Implications
The nomogram can assist clinicians in predicting the risk of metastasis in ARM lymph nodes.
Conclusion
The developed nomogram provides a tool for predicting ARM lymph node metastasis.
