Sentinel Lymph Node Metastasis

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Our sentinel lymph node metastasis nomogram is a tool designed for patients newly diagnosed with breast cancer to estimate the likelihood that cancer has spread to the sentinel lymph nodes (the first nodes to which the cancer would spread in the breast and underarm region). It predicts any finding of cancer cells in the sentinel lymph nodes, including cells found by immunohistochemical staining only, a finding currently staged as pN0(+). This nomogram is not appropriate for patients who have already undergone neoadjuvant therapy (treatment such as chemotherapy, hormone therapy, or other drugs given before surgery). It is also not a substitute for a sentinel lymph node biopsy. This tool is intended for use in consultation with a physician.

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 patients had their sentinel nodes examined by serial sectioning and cytokeratin immunohistochemical staining. 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
years (20 to 91)
cm (0.1 to 11)
Why is size important?
Tumor size is directly related to risk of sentinel node metastases (see figure below).
Is your breast cancer a special type?
What is special type?
Special types are defined on the pathology report as pure tubular, pure colloid (mucinous), or typical medullary carcinomas. Other types, such as atypical medullary carcinoma or carcinoma with ductal and lobular features, must be classified as ductal, and are not considered special types.
Is your tumor confined to the upper inner quadrant of the breast? (This nomogram compares the upper inner quadrant against other quadrants within the breast.)
Was lymphovascular invasion or permeation (tumor cells seen in the blood or lymphatic vessels) listed on your pathology report?
Is your breast tumor multifocal?
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 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 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.
What is PR?
PR stands for progesterone receptors. Breast cancer cells that are PR-positive have progesterone receptors on their surface. PR-positive tumors can be treated with endocrine therapies that prevent progesterone from fueling the cancer cells. PR-negative tumors don’t have these receptors on their surface.
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