Predictors of Nonsentinel Nodal Involvement to Aid Intraoperative Decision Making in Breast Cancer Patients with Positive Sentinel Lymph Nodes

Background . Up to 60% of patients with a positive sentinel lymph node (SLN) have no additional nodal involvement and do not benefit from completion axillary lymph node dissection (ALND). We aim to identify factors predicting for non-SLN involvement and to validate the MSKCC nomogram and Tenon score in our population. Methods . Retrospective review was performed of 110 consecutive patients with positive SLNs who underwent ALND over an 8-year period. Results . Fifty patients (45%) had non-SLN involvement. Non-SLN involvement correlated positively with the number of positive SLNs ( P = 0.04), macrometastasis ( P = 0.01), and inversely with the total number of SLNs harvested ( P = 0.03). The MSKCC nomogram and Tenon score both failed to perform as previously reported. Conclusions . The MSKCC nomogram and Tenon score have limited value in our practice. Instead, we identified three independent predictors, which are more relevant in guiding the intraoperative decision for ALND.