Patient selection: breast cancer with positive sentinel lymph node biopsy
Criteria for axillary lymph node dissection - both of the following:
(1) macrometastases in the sentinel lymph node(s)
(2) number of risk factors for metastases to non-sentinel lymph nodes
Risk factors for metastases to non-sentinel lymph nodes:
(1) primary tumor size in cm
(2) presence of extranodal growth in sentinel lymph nodes (extracapsular)
(3) number of negative sentinel nodes
|
Parameter
|
Finding
|
Points
|
|
primary tumor size
|
<= 2 cm
|
0
|
|
|
> 2 cm
|
1
|
|
extranodal growth
|
no
|
0
|
|
|
yes
|
1
|
|
number of negative sentinel lymph nodes
|
0
|
1
|
|
|
>= 1
|
0
|
number of risk factors =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
The decision to perform an axillary node dissection versus radiation alone depends on a number of factors. The benefits and risk of an axillary dissection need to be considered along with the patient's preferences.
