Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN

Eur J Surg Oncol. 2011 Apr;37(4):290-9. doi: 10.1016/j.ejso.2011.01.006. Epub 2011 Feb 12.


Aims: A meta-analysis was performed to identify the clinicopathological variables most predictive of non-sentinel node (NSN) metastases when the sentinel node is positive.

Methods: A Medline search was conducted that ultimately identified 56 candidate studies. Original data were abstracted from each study and used to calculate odds ratios. The random-effects model was used to combine odds ratios to determine the strength of the associations.

Findings: The 8 individual characteristics found to be significantly associated with the highest likelihood (odds ratio >2) of NSN metastases are SLN metastases >2mm in size, extracapsular extension in the SLN, >1 positive SLN, ≤1 negative SLN, tumour size >2cm, ratio of positive sentinel nodes >50% and lymphovascular invasion in the primary tumour. The histological method of detection, which is associated with the size of metastases, had a correspondingly high odds ratio.

Conclusions: We identified 8 factors predictive of NSN metastases that should be recorded and evaluated routinely in SLN databases. These factors should be included in a predictive model that is generally applicable among different populations.

Publication types

  • Meta-Analysis

MeSH terms

  • Axilla
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / surgery
  • Female
  • Humans
  • Lymph Node Excision*
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis / diagnosis
  • Odds Ratio
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Sentinel Lymph Node Biopsy*