Additional Nodal Metastases

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Our additional nodal metastases nomogram is a tool designed to estimate the likelihood that cancer has spread beyond the sentinel lymph nodes (the first nodes to which the cancer would spread in the breast and underarm region) to other non-sentinel nodes under the arm. It is appropriate for individual patients with primary invasive breast cancer that has already spread to the sentinel lymph nodes, but is not appropriate for patients in whom enlarged metastatic nodes could be felt on physical examination. It is also not appropriate for patients who have already had systemic therapy (chemotherapy or hormone therapy) or radiation therapy for this breast cancer. This tool has been externally validated at more than 20 institutions across Europe and North America (see Supporting Publications) and the original study was recognized as the most cited paper in 2007 by the Annals of Surgical Oncology.

Results produced by this tool are based on data from patients treated at MSK, a large research institution with surgeons who perform a high volume of breast cancer procedures. All results must be understood in the context of each patient’s specific treatment plan. Patients and caregivers using this tool should discuss the result with the patient’s physician.

To gather the information required to use this nomogram, use our worksheet.

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All fields are required unless noted optional

Was a frozen section analysis performed on the sentinel lymph node biopsy? (This need not have been the method that detected cancer in the sentinel lymph nodes.)

Yes

What is frozen section analysis?: Frozen section analysis is a pathologic laboratory procedure to perform rapid microscopic analysis of a specimen.

What was the size of your primary breast tumor? cm (0.1 to 9)

What is the type of your primary breast tumor? If the type is ductal, what grade is it? (If the type is ductal/lobular mixed tumor, select ductal and the corresponding grade in the pathology report.)

What are type and grade?: Tumor type and grade are routinely noted in the pathology report. A tumor is either ductal or lobular. Ductal and lobular are the most common growth patterns of breast cancer. Grade refers to the extent of abnormality of the cells when viewed under the microscope. Nuclear grades I to III refer to variation in the size and shape of the nuclei of the tumor cells.

What was the number of positive (cancerous) sentinel lymph nodes? nodes (1 to 7)

What method was used to detect cancer cells in the sentinel lymph nodes?

More on methods of detection: Pathologists detect cancer cells in the sentinel lymph nodes using different staining methods. The method used -- frozen section, routine histopathology (Routine H&E), H&E stains of serial sections (Serial H&E), or immunohistochemistry (IHC) -- is stated on the pathology report.

What was the number of negative (non-cancerous) sentinel lymph nodes? nodes (0 to 14)

Was lymphovascular invasion or permeation (tumor cells seen in the blood or lymphatic vessels) listed on your pathology report?

Yes

Is your primary tumor multifocal?

Yes

What is multifocality?: Breast cancers that grow as separate groups of tumor cells rather than as one unified tumor mass are described as being “multifocal.”

What is the estrogen receptor (ER) status of your tumor? (For this nomogram, ER-positive is defined as at least 10% of the cells being positive; ER-negative is defined as less than 10% of the cells being positive.)

What is ER?: ER stands for estrogen receptor. Breast cancer cells that are ER-positive have estrogen receptors on their surface. ER-positive tumors can be treated with endocrine therapies that prevent estrogen from fueling the cancer cells. ER-negative tumors don’t have these receptors on their surface.

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