Abstract
Routine axillary dissection is primarily used as a means of assessing prognosis to establish appropriate treatment plans for patients with primary breast carcinoma. However, axillary dissection offers no therapeutic benefit to node negative patients and patients may incur unnecessary morbidity, including mild to severe impairment of arm motion and lymphedema, as a result. This paper outlines a method of evaluating the probability of harbouring lymph node metastases at the time of initial surgery by assessment of tumour based parameters, in order to provide an objective basis for further selection of patients for treatment or investigation. The novel aspect of this study is the use of Maximum Entropy Estimation (MEE) to construct probabilistic models of the relationship between the risk factors and the outcome. Two hundred and seventeen patients with invasive breast carcinoma were studied. Surgical treatment included axillary clearance in all cases, so that the pathologic status of the nodes was known. Tumour size was found to be significantly correlated (P < 0.001) to the axillary lymph node status in the multivariate analysis with age (P = 0.089) and vascular invasion (P = 0.08) marginally correlated. Using the multivariate model constructed, 38 patients were predicted to have risk of nodal metastases lower than 20%, of these only 4 (10%) patients had lymph node metastases. A comparison with the Multivariate Logistic Regression (MLR) was carried out. It was found that the predictive quality of the MEE model was better than that of the MLR model. In view of the small sample size, further verification of this model is required in assessing its practical application to a larger population.
References
Bonadonna G: Conceptual and practical advances in the management of breast cancer. J Clin Oncol 7: 1380–1397, 1989
Cady B: Lymph node metastases. Indicators, but not governors of survival. Arch Surg 119: 1067–1072, 1984
Cady B: The Need to reexamine axillary lymph node dissection in invasive breast cancer. Cancer 73: 505–508, 1994
Chadha M, Chabon AB, Friedmann P, Vikram B: Predictors of axillary lymph node metastases in patients with T1 breast cancer. Cancer 73: 350–353, 1994
Danforth DN, Findlay PA, McDonald HD, Lippman ME, Reichert CM, d'Angelo T, Gorrell CR, Gerber NL, Lichter AS, Rosenberg SA, deMoss ES: Complete axillary lymph node dissection for Stage I–II carcinoma of the breast. J Clin Oncol 4: 655–662, 1986
Davis GC, Rosemary RM, Hayward JL: Assessment of axillary lymph node status. Ann Surg 192: 148–151, 1980
Dawkins HJS, Goodall RJ, Hahnel E, Sarna M, Robbins PD: nm23-H1 metastasis supressor gene expression in primary breast cancer: Association with axillary lymph node status, tumour size, type and grade.The Breast, submitted
Deckers PJ: Axillary dissection in breast cancer: When, why, how much and for how long? Another operation soon to be extinct? J Surg Oncol 48: 217–219, 1991
Elston CW, Ellis IO: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long term follow-up. Histopathology 19: 403–410, 1991
Fentiman IS, Mansel RE: The axilla: not a no-go zone. Lancet 337: 221–223, 1991
Fentiman IS: Axillary surgery in breast cancer — Is there still a debate? Eur J Cancer 28A: 1013–1014, 1992
Fisher B, Slack NH, Bross IDJ and Cooperating Investigators: Cancer of the Breast: Size of neoplasm and prognosis. Cancer: 1071–1080, 1969.
Fisher ER, Swamidoss S, Lee CH, Rockette H, Redmond C, Fisher B: Detection and significance of occult axillary node metastases in patients with invasive breast cancer. Cancer 42: 2025–2031, 1978
Fisher B, Redmond C, Fisher ER, Bauer M, Wolmark N, Wickerham L, Deutsch M, Montague E, Margolese R, Foster R: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312: 674–681, 1985
Fougere PF: Maximum Entropy Calculations on Discrete Probability Space. Maximum Entropy and Bayesian Methods in Science and Engineering 1 [GJ Erickson and CR Smith (eds)]: 205–304, 1988
Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT: Assessment of morbidity from complete axillary dissection. Br J Cancer 66: 136–138, 1992
Jaynes ET: On the rationale of maximum entropy methods. Proc IEEE 70: 939–952, 1982
Jaynes ET: Papers on Probability, Statistics and Statistical Physics. D Reidel Pub Company, 1983, pp 317–335
Kesavan HK, Kapur JN: The generalized maximum entropy principle. IEEE Trans Sys Man and Cybernetics 19: 1042–1052, 1989
Lippman ME, Livter AS, Danforth DN: Diagnosis and Management of Breast Cancer, W.B. Saunders Company, 1988
Habbema JDF, Hilden J, Bjerregaard B: The measurement of performance in probabilistic diagnosis I. The problem, descriptive tools, and measures based on classification matrices. Methods of Information in Medicine 17: 217–226, 1978
Harris JR, Osteen RT: Patients with early breast cancer benefit from effective axillary treatment. Breast Cancer Research and Treatment 5: 17–21, 1985
Harvey JM, deKlerk NH, Sterrett GF: Histological grading in breast cancer: Interobserver agreement, and relation to other prognostic factors including ploidy. Path 24: 403–410, 1991
Hayward J, Caleffi M: The significance of local control in the primary treatment of breast cancer. Arch Surg 122: 1244–1247, 1987
Hosmer DW, Lemeshow S: Applied Logistic Regression. John Wiley & Sons Inc, 1989
Huvos AG, Hutter RVP, Berg JW: Significance of axillary macrometastases and micrometastases in mammary cancer. Ann Surg 173: 44–46, 1971
International (Ludwig) Breast Cancer Study Group: Prognostic importance of occult axillary lymph node microme-tastases from breast cancers. The Lancet 335: 1565–1568, 1990
McCullagh P, Nelder JA: Generalized Linear Models. Chapman Hall, London, 1983
Mittra I: Axillary lymph node metastasis in breast cancer: Prognostic indicator or lead-time bias. Eur J Cancer 29A: 300–302, 1993
Page DL, Anderson TJ: Diagnostic Histopathology of the Breast, Longman Group UK Ltd, 1987
Silverstein MJ, Rosser RJ, Gierson ED, Waisman JR, Gamagami P, Hoffman RS, Fingerhut AG, Lewinsky BS, Colburn W, Handel N: Axillary lymph node dissection for intraductal breast carcinoma — Is it indicated? Cancer 59: 1819–1824, 1987
Silverstein MJ, Gierson ED, Waisman JR, Senofsky GM, Colburn WJ, Gamagami P: Axillary lymph node dissection for Tla breast carcinoma. Is it indicated? Cancer 73: 664–667, 1994
Shannon CE: A mathematical theory of communication. The Bell System Technical Journal 27: 379–423, 1948
Spiegelhalter DJ: Probabilistic prediction in patient management and clinical trials. Stat Med 5: 421–433, 1986
Shore JE, Johnson RW: Axiomatic derivation of the principle of maximum entropy and the principle of minimum cross-entropy. IEEE Trans Inf Theory 26: 26–37, 1980
Wallace IW, Champion HR: Axillary nodes in breast cancer. The Lancet: 217–218, 1972
Wood WC: Integration of risk factors to allow patient selection for adjuvant systemic therapy in lymph node-negative breast cancer patients. World J Surg 18: 39–44, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Choong, P.L., deSilva, C.J.S., Dawkins, H.J.S. et al. Predicting axillary lymph node metastases in breast carcinoma patients. Breast Cancer Res Tr 37, 135–149 (1996). https://doi.org/10.1007/BF01806495
Issue Date:
DOI: https://doi.org/10.1007/BF01806495