Predictive Factors Among Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in T1-T2 Breast Cancer

Shigeki Minami,¹ Chika Sakimura,¹ Junji Irie,² Yukiko Tokai,³ Hitoshi Okubo,⁴ Tsuyoshi Ohno<sup>5

1</sup>Department of Breast and Endocrine Surgery, Nagasaki Harbor Medical Center, Nagasaki 850-8555, Japan; ²Department of Pathology, Nagasaki Harbor Medical Center, Nagasaki, Japan; ³Department of Breast Surgery, Imamura Women’s Clinic, Nagasaki, Japan; ⁴Okubo Breast Clinic, Nagasaki, Japan; ⁵Ohno Breast and Thyroid Clinic, Nagasaki, Japan

Correspondence: Shigeki Minami
Department of Breast and Endocrine Surgery, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki 850-8555, Japan
Tel +81-95-822-3251
Fax +81-95-826-8798
Email br9-origam@umin.net

Background: The axillary lymph node status is an important prognostic factor of breast cancer. This study explores the predictive factors for sentinel lymph node (SLN) metastasis among the preoperative clinicopathological features, including impaired glucose tolerance (IGT).
Methods: This study comprised patients diagnosed with breast cancer who underwent surgery at Nagasaki Harbor Medical Center between April 2014 and December 2019. The factors assessed using univariate and multivariate analyses were the clinicopathological data of these cancers, including the patient age, gender, menstrual status, breast or ovarian cancer family history, body mass index, glycosylated hemoglobin, clinical tumor size, nipple-tumor distance (NTD), tumor histology, histological grade, node status, estrogen receptor, progesterone receptor, human epidermal growth factor receptor type 2 status, and Ki67 labeling index.
Results: In the cohort of 313 cases, the ratio of SLN metastasis was 17.3%. A univariate analysis found that the tumor size, NTD, IGT, and clinical tumor stage were associated with SLN metastasis. In a multivariable analysis, the tumor size, NTD, and IGT were associated with SLN metastasis. The receiver operating characteristic curve showed a sensitivity and specificity of 61.1% and 65.6%, respectively, at a cut-off of 1.7 cm for the tumor size (area under the curve [AUC]: 0.664; 95% confidence interval: 0.592– 0.736), and a sensitivity and specificity of 60.4% and 62.9%, respectively, at a cut-off of 2.0 cm for NTD (AUC: 0.651; 95% confidence interval: 0.571– 0.731) to predict the risk of SLN metastasis.
Conclusion: T1 and T2 breast cancer patients with a larger tumor size, tumor located closer to the nipple, and IGT have a higher risk of SLN metastases than others.

Keywords: breast cancer, sentinel lymph node metastasis, predictive factor, nipple-tumor distance, impaired glucose tolerance