{"paper_id":"016eee3c-e07d-44f6-bcf6-659eb676181d","body_text":"Risk factors of non-sentinel lymph node metastasis in breast cancer with 1–2 sentinel lymph node micrometastases: a case control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors of non-sentinel lymph node metastasis in breast cancer with 1–2 sentinel lymph node micrometastases: a case control study Zhen Huang, Zhe Wu, Quan-qing Zou, Yu-jie Xie, Li-hui Li, Yan-ping Huang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2091343/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Apr, 2023 Read the published version in World Journal of Surgical Oncology → Version 1 posted 8 You are reading this latest preprint version Abstract Backgrround The randomized trials include ACOSOG Z0011 and IBCSG 23 − 01 had found that, the survival rates were not different in patients with cT1/2N0 and 1–2 sentinel lymph node (SLN) positive, macro/micro metastases who underwent breast-conserving therapy and micrometastases who underwent total mastectomy (TM), when axillary lymph node dissection (ALND) was omitted. However, for patients with cT1/2N0 and 1–2 SLN macrometastases who underwent TM, there was no published clinical research evidence whether ALND can be exempted. This study aimed to investigate the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1–2 SLN macrometastases undergoing TM. Methods The clinicopathological data of 1491 breast cancer patients underwent TM and SLNB from January 2017 to February 2022 were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for nSLN metastasis. Results A total of 273 patients with 1–2 SLN macrometastases underwent TM were enrolled. Postoperative pathological data showed that 35.2% patients had nSLN metastasis. The results of multivariate analysis indicated that tumor size (TS) (P = 0.002; OR: 1.051; 95% CI: 1.019–1.084) and ratio of SLN macrometastases (P = 0.0001; OR: 12.597: 95% CI: 4.302–36.890) were the independent risk factors for nSLN metastasis in breast cancer with 1–2 SLN macrometastases underwent TM. The ROC curve analysis suggested that when TS ≤ 22mm and ratio of SLN macrometastases ≤ 0.33, the incidence of nSLN metastasis could be reduced to 17.1%. Conclusions The breast cancer patients with cT1/2N0 stage, undergoing TM and 1–2 SLN macrometastases, when the TS ≤ 22mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, and whether ALND can be exempted deserves further exploration. Breast cancer Total mastectomy Sentinel lymph node Macrometastasis non-Sentinel lymph node Risk factor Figures Figure 1 Figure 2 Figure 3 Background In recent years, with the continuous rising of incidence, breast cancer has become one of the most common malignant tumors harmful to women's health. The axillary lymph node dissection (ALND) used to be the standard treatment of axillary surgery for early breast cancer. However, the complications such as upper limb motor dysfunction, lymphedema, and sensory loss that may be caused by ALND seriously affect nearly 39% of postoperative patients [ 1 ]. With the application of sentinel lymph node biopsy (SLNB) and the support of its safety studies, the surgical management of the axillary in breast cancer patients has undergone major changes [ 2 ]. For patients with cN + before surgery, ALND is still recommended. However, for patients with cN0, SLNB should be recommended as much as possible after being informed of its safety and possible risks to reduce the risk of postoperative complications. Among them, for patients with positive sentinel lymph node (SLN), according to the ACOSOG Z0011 study, it is safe and feasible to avoid ALND in patients with cT1/2N0 and 1–2 SLN positive (macro/micro metastases) who receive breast-conserving therapy (BCT) [ 3 ]. For patients with cT1/2N0 and 1–2 SLN micrometastases who underwent total mastectomy (TM), ALND exemption can also be considered based on the results of the IBCSG 23 − 01 study [ 4 ]. For patients with cT1/2N0 and 1–2 SLN macrometastases who underwent TM, the EORTC AMAROS study supports the safe and feasible replacement of ALND by axillary radiotherapy (ART) [ 5 ]. However, there is still insufficient evidence from clinical studies to support whether further axillary treatment including ALND or ART can be safely exempted. In previous studies, a variety of clinicopathological factors have been considered to be associated with non-sentinel lymph node (nSLN) metastasis in SLN-positive breast cancer [ 6 – 9 ]. This study will further explore the risk factors related to nSLN metastasis in patients under specific conditions with cT1/2N0 stage, undergoing TM and 1–2 SLN macrometastases. It is helpful for clinical identification of low-risk patients with nSLN metastasis under such conditions, so as to guide the treatment decision whether ALND or ART can be exempted. Methods Patients and data collection The clinicopathological data of patients with invasive breast cancer who underwent TM and SLNB in the People's Hospital of Guangxi Zhuang Autonomous Region and the Fourth Affiliated Hospital of Guangxi Medical University from January 2017 to February 2022 were retrospectively analyzed. SLN-positive patients underwent further ALND. The clinicopathological data included: age, BMI, total number of SLN, number of negative SLN, ratio of SLN macrometastases, preoperative neutrophil lymphocyte ratio (NLR), tumor size (TS), lymphovascular invasion (LVI), histological grade, human epidermal growth factor receptor-2 (HER2) status, estrogen receptor (ER) status, progesterone receptor (PR) status, Ki-67 index, pathological type, multifocal lesions, family history of malignancy and menstrual status, etc. Inclusion and exclusion criteria Inclusion criteria: (1) Diagnosed with invasive breast cancer and received TM and axillary SLNB; (2) TS ≤ 5cm with cN0 (no palpable enlarged lymph nodes, no abnormal morphological and echoic lymph nodes were found on ultrasound) [10]; (3) With 1–2 macrometastatic SLN and underwent ALND; Exclusion criteria: (1) SLN was negative, only isolated tumor cell clusters or micrometastases, and ≥ 3 macrometastases were found during operation; (2) Received neoadjuvant therapy; (3) Incomplete clinicopathological data; SLNB and ALND procedure After anesthesia and disinfection, take 2 ml of 1% methylene blue were injected into the areola subcutaneously 5– 10 minutes before surgery. Blue-stained lymph nodes and their adjacent enlarged non-blue-stained lymph nodes were searched along the blue-stained lymphatic vessels as SLN and sent for intraoperative frozen pathological diagnosis. SLN-positive patients underwent further ALND. Axillary lymph nodes were routinely dissected at level I to II, and some patients were dissected to level III. Judgment criteria Histological grade [11]: Using the modified Scarff-Bloom-Richardson grading system: according to the proportion of glandular tube formation, cell atypia and mitotic count, each of the three indicators was independently assessed and given 1–3 points. The histological grade of invasive carcinoma was divided into grade Ⅰ (3–5 points), grade Ⅱ (6–7 points) and grade Ⅲ (8–9 points) according to the combined total score. Tumor size: The pathological findings (gross and microscopic measurements) size of a primary tumor were the main results, combined with imaging modalities such as mammography, ultrasound, and MR imaging. For patients with intraductal carcinoma, the size of the invasion was the criterion. Types of SLN metastasis: According to definitions of the American Joint Committee on Cancer (AJCC). ITCs is defined as small clusters of cells ≤ 0.2 mm, or single tumor cells, or fewer than 200 cells in a single histologic cross-section. Micrometastasis is defined as tumor deposits > 0.2 mm but ≤ 2.0 mm in largest dimension. Macrometastasis is defined as tumor deposits > 2.0 mm in largest dimension. Ratio of SLN micrometastases: The ratio of the number of macrometastatic SLN to the total number of SLN. Statistical analysis The SPSS 23 Statistics software application was used to perform to determine risk factors. Chi-squared test was usually used for categorical data, while Students T test or Wilcoxon Rank Sum was used for continuous measurement data. Multivariate unconditional logistic regression analysis was used for multivariate correlation analysis. The diagnostic accuracy was assessed by receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) was used to evaluate the critical value of relevant factors. P < 0.05 was considered to indicate a statistically significant difference. Results Patients and treatments A total of 1,491 patients with invasive breast cancer underwent TM and SLNB, all of whom were female. Among them, patients with SLN 1–2 macrometastases accounted for 18.3% (n = 273), with an average age of 51.5 years. Pathological data after ALND showed that a total of 35.2% (n = 96) patients developed nSLN metastasis (Figure 1). Univariate and multivariate analyses The comparison of clinicopathological factors showed that there were significant differences in total number of SLN, number of negative SLN, ratio of SLN macrometastases, TS, LVI, pathological type and tumor site between the nSLN-positive and nSLN-negative patients (P < 0.05), while There was no significant difference between the two groups in age, BMI, NLR, histological grade, molecular type, ER status, PR status, Ki-67 index, HER2 status, multifocal lesions, menstrual status and family history of malignancy (Table 1). The clinicopathological factors of total number of SLN, number of negative SLN, ratio of SLN macrometastases, TS, LVI, pathological types and tumor sites were included in multivariate analysis. The results indicated that TS (P = 0.002; OR: 1.051; 95% CI: 1.019–1.084) and Ratio of SLN macrometastases (P = 0.0001; OR: 12.597; 95% CI: 4.302–36.890) were the independent risk factors for nSLN metastasis in breast cancer with 1–2 SLN macrometastases undergoing TM (Table 2). ROC analysis of TS and ratio of SLN macrometastases The cut-off points of TS and ratio of SLN macrometastases determined by receiver operating characteristic (ROC) analysis were 22mm (AUC 0.625, sensitivity 60.4%, specificity 64.4%, P < 0.001, Figure 2) and 0.33 (AUC 0.680, sensitivity 64.6%, specificity 65.5%), P < 0.001, Figure 3), respectively. When TS > 22mm and ratio of SLN macrometastases > 0.33, the incidence of nSLN metastasis was 73.6%, and when TS ≤ 22mm and Ratio of SLN macrometastases ≤ 0.33, the incidence of nSLN metastasis decreased to 17.1% (Table 3). Discussion In the comprehensive treatment of breast cancer, surgery still has an irreplaceable clinical status. With the gradual change of the treatment concept, the principle of surgical treatment has shifted from maximum tolerable treatment to minimum effective treatment. The SLNB technique has become a routine axillary treatment for patients with clinically node-negative breast cancer. For SLN-positive breast cancer patients, ALND is still the primary treatment [ 12 ]. However, 34.3–77.3% of patients with SLN-positive were found to have no nSLN metastasis after ALND [ 6 , 8 , 10 ]. With the announcement of the 10-year follow-up results of the ACOSOG Z0011 trial [ 3 ] and the IBCSG 23 − 01 trial [ 4 ], TM with 1–2 SLN micrometastases and BCT with 1–2 SLN micro/macro metastases of breast cancer patients, it is safe to avoid ALND. However, whether patients with TM and 1–2 SLN macrometastases can be exempted from ALND is still insufficient evidence from clinical studies. Among this study, the patients with TM and 1–2 SLN macrometastases, 64.8% of the patients did not develop nSLN metastasis. Means that it did not benefit from having undergone ALND surgery. To explore the risk factors related to nSLN metastasis in patients undergoing TM and 1–2 SLN macrometastases, and screen the patients who can avoid ALND, which is of great significance to reduce the trauma caused by surgery. There have been many previous studies on the risk factors related to SLN-positive and nSLN metastasis in breast cancer, but few studies have focused on the conditions of TM with SLN macrometastases. Previous studies have found that the size of SLN metastases, extracapsular invasion of SLN, the number of positive and negative SLN, the ratio of positive SLN, TS, LVI, histological grade, NLR and other clinicopathological factors were all related to the occurrence of nSLN metastasis [ 6 – 9 ]. In the analysis of our group, under the conditions of cT1/2N0 and TM with 1–2 SLN macrometastases, we found that the total number of SLN, number of negative SLN, ratio of SLN macrometastases, TS, LVI, pathological type and tumor site were correlated with the occurrence of nSLN metastasis. Multivariate analysis further found that TS and ratio of SLN macrometastases were independent predictors of nSLN metastasis. When TS > 22mm and ratio of SLN macrometastases > 0.33, the incidence of nSLN metastasis was 73.6%, and when TS ≤ 22mm and ratio of SLN macrometastases ≤ 0.33, the incidence of nSLN metastasis decreased to 17.1%. It is suggested that selecting a small tumor burden before surgery and increasing the number of SLN detected during surgery can improve the accuracy of negative prediction of nSLN. It has important reference value for evaluating whether to exempt ALND. Although ALND is currently recommended for patients with SLN-positive breast cancer undergoing TM, the real-world data on SLN-positive disease without ALND are equally noteworthy. Among the entire study cohort of 4093 patients had T1/2N0M0 breast cancer with 1–2 SLN metastases and underwent TM. ALND rates decreased from 89.9% in 2010 to 55.5% in 2015. Rates decreased from 82–8% in patients with SLN micrometastases and from 93–63% in those with macrometastases. In multivariable analysis, factors associated with omission of ALND were pT1 status, older age, more SLN removed, fewer positive SLN, and SLN micrometastasis [ 13 ]. In addition, in another study of 329 patients with 1–2 SLN metastases who underwent TM, 201 patients received ALND. Compared with patients who received SLNB alone, patients who received ALND were characterized by higher tumor grade and higher proportion of hormone receptor-negative. After a median follow-up of 51 months, there were no significant differences in OS and local recurrence rates between the two groups [ 14 ]. Kim and his colleagues observed 3632 breast cancer patients who underwent TM with 1–2 SLN metastases, of which 883 patients did not receive ALND. No difference in OS between the two groups at a median follow-up of 54 months [ 15 ]. All the above data suggest that it appears to be safe to avoid ALND in breast cancer patients with TM and 1–2 SLN metastases when selecting appropriate low-risk cases. There have been several prospective controlled studies on whether axillary treatment can be exempted for patients with 1–2 SLN macrometastases undergoing TM. Among them, the SINODAR ONE study was a prospective noninferiority multicenter randomized study aimed at assessing the role of ALND in patients undergoing either BCT or TM for T1–2 breast cancer and presenting 1–2 SLN macrometastases. It was no significant differences in OS or RFS between ALND recipients and non-ALND recipients at a mean follow-up of 32 months in the 879 cases [ 16 ]. However, the low proportion of patients who underwent TM (24.8%) and the short follow-up time in this study still cannot alone answer the question of whether breast cancer patients who underwent TM with 1–2 SLN macrometastases can be exempted from ALND. In addition, SENOMAC and POSNOC studies are still in progress. The SENOMAC study, a non-inferiority study largely follows the inclusion criteria of the ACOSOG Z0011 study, but allows the inclusion of T1–3 patients who undergoing TM. A total of 3500 patients are randomized 1:1 to either undergo ALND or not, and the primary endpoint is breast cancer-specific survival at 5 years [ 17 ]. The POSNOC study is a randomised, multi-centre, non-inferiority trial, aimed to evaluate whether breast cancer patients with T1-2, 1–2 SLN macrometastases who undergoing TM or BCT without axillary treatment are non-inferior to ALND or ART. The sample size is 1900 and participants will be followed up for 5 years. The primary endpoint is axillary recurrence at 5 years. By June 2021, POSNOC study had completed 1866 cases [ 18 ]. The results of the ACOSOG Z0011 and IBCSG 23 − 01 studies have changed the previous breast cancer treatment strategy. We expect the new research results will lead to new treatment decisions. In the just-published SENOMAC study of health-related quality of life and arm morbidity after axillary surgery, 976 patients (501 in SLNB and 475 in ALND) were enrolled, found that arm morbidity was significantly worse affected by ALND than by SLNB one year after surgery. The results underline the importance of ongoing attempts to safely de-escalate axillary surgery [ 19 ]. This study is a retrospective study. The subject of the study is the breast cancer patients with T1/2, cN0 and TM with 1–2 SLN macrometastases that had not yet been supported by the results of randomized controlled studies. The study comprehensively evaluated the influence of different clinicopathological factors on nSLN metastasis and further analyzed the role of related influencing factors. It has certain reference significance for choosing whether to exempt ALND in clinical practice. However, there are some uncontrolled research biases in this study, which may have a certain impact on the results. We look forward to more randomized controlled studies to evaluate the safety of ALND exclusion in breast cancer patients with T1/2, cN0 and TM with 1–2 SLN macrometastases. Conclusions the breast cancer patients with cT1/2N0 stage, undergoing TM and 1–2 SLN macrometastases, the occurrence of nSLN metastasis is closely related to TS and the ratio of SLN macrometastases. when the TS ≤ 22mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, and whether ALND can be exempted deserves further exploration. Abbreviations TM, Total mastectomy BTC, Breast-conserving therapy SLN, Sentinel lymph node nSLN, non-Sentinel lymph node SLNB, Sentinel lymph node biopsy ALND, Axillary lymph node dissection ART, Axillary radiotherapy NLR, Neutrophil lymphocyte ratio TS, Tumor size LVI, Lymphovascular invasion ER, Estrogen receptor PR, Progesterone receptor HER2, Human epidermal growth factor receptor-2 ROC, Receiver operating characteristic AUC, The area under the ROC curve Declarations Ethics approval and consent to participate The study was approved by the Institutional Ethics Review Board of the People's Hospital of Guangxi Zhuang Autonomous Region and the Fourth Affiliated Hospital of Guangxi Medical University. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This study received funding from Guangxi Zhuang Autonomous Region Health Commission Self-funded scientific research project (Z20200134) Authors' contributions JRY: study conception and design, interpretation of results; ZH: study conception and design, data collection and analysis, draft manuscript preparation; ZW and YJX：data collection and analysis, draft manuscript preparation; LHL, YPH, FMW, DH, and YHP: data collection. All authors approved the final version of the manuscript. Acknowledgements Not applicable Authors' information Jian-rong Yang: Department of Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530021, China, E-mail: [email protected] References Pusic AL, Cemal Y, Albornoz C, et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv. 2013;7:83–92. Wong W, Rubenchik I, Nofech-Mozes S, et al. Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy. Technol Cancer Res Treat. 2019;01:1–6. Giuliano AE, Ballman K, McCall L, et al. Locoregional Recurrence After Sentinel Lymph Node Dissection with or Without Axillary Dissection in Patients with Sentinel Lymph Node Metastases: Long-term Follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264:413–420. Galimberti V, Cole BF, Viale G. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018;19:1385–1393. Sandoughdaran S, Malekzadeh M, Mohammad Esmaeil ME. Frequency and Predictors of Axillary Lymph Node Metastases in Iranian Women with Early Breast Cancer. Asian Pac J Cancer Prev. 2018;19:1617–1620. van la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol. 2011;37:290–299. Ibrahim A, Serkan YF, Tuba A, et al. Can Neutrophil to Lymphocyte Ratio Be a Predictor Tool for The Non-Sentinel Lymph Node Metastasis in Breast Cancer? Chirurgia (Bucur). 2019;114:83–88. Wang XY, Wang JT, Guo T, et al. Risk factors and a predictive nomogram for non-sentinel lymph node metastases in Chinese breast cancer patients with one or two sentinel lymph node macrometastases and mastectomy. Curr Oncol. 2019;26:210–215. Zhou Y, Huang X, Mao F, et al. Predictors of nonsentinel lymph node metastasis in patients with breast cancer with metastasis in the sentinel node. Medicine (Baltimore). 2019;98:1–7. Zheng J, Cai S, Song H, et al. Positive non-sentinel axillary lymph nodes in breast cancer with 1–2 sentinel lymph node metastases. Medicine (Baltimore). 2018;97:1–6. Bansal C, Pujani M, Sharma KL, et al. Grading systems in the cytological diagnosis of breast cancer: a review. J Cancer Res Ther. 2014;10:839–845. Gipponi M, Bassetti C, Canavese G, et al. Sentinel lymph node as a new marker 407 for therapeutic planning in breast cancer patients. J Surg Oncol. 2004;85:102–111. Hennigs A, Riedel F, Feißt M, et al. Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study[J]. Ann Surg Oncol. 2019;26:2435–2443. Sun J, Mathias BJ, Laronga C, et al. Impact of Axillary Dissection Among Patients with Sentinel Node-Positive Breast Cancer Undergoing Mastectomy. J Natl Compr Canc Netw. 2021;19:40–47. Kim BK, Park BW, Hur MH, et al. Omission of axillary lymph node dissection in patients who underwent total mastectomy with 1 or 2 metastatic lymph nodes. Ann Surg Treat Res. 2020;98:283–290. Tinterri C, Gentile D, Gatzemeier W, et al. Preservation of Axillary Lymph Nodes Compared with Complete Dissection in T1-2 Breast Cancer Patients Presenting One or Two Metastatic Sentinel Lymph Nodes: The SINODAR-ONE Multicenter Randomized Clinical Trial. ANN SURG ONCOL, 2022;29:5732–5744. de Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer. 2017;17:379. Goyal A, Mann GB, Fallowfield L, et al. POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes. BMJ Open. 2021;11: e054365. Appelgren M, Sackey H, Wengström Y, et al. Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial. Breast. 2022;01:16–23. Tables Table 1. Relationship between nSLN and clinicopathological factors Characteristic nSLN-negative (n = 177) nSLN-positive (n = 96) t/z/x 2 P Value Age at diagnosis (year) 51.24 ± 10.44 51.89 ± 11.93 -0.466 0.642 BMI (kg/m 2 ) 23.31 (21.24–25.89) 23.12 (21.40–26.43) -0.707 0.480 TS (mm) 20 (15–25) 25 (20–30) -3.429 0.001 Total number of SLN 4 (3–5) 3 (2–4) -2.937 0.003 Number of negative SLN 2.00 (1.00–4.00) 1.50 (0.25–3.00) -3.959 0.001 Ratio of SLN macrometastases 0.33 (0.25–0.50) 0.50 (0.33–0.92) -4.987 0.001 NLR 1.99 (1.61–2.68) 2.00 (1.53–2.67) -0.803 0.423 Histological grade 6.428 0.093 Ⅰ 20 (11.3) 3 (3.1) Ⅱ 113 (63.8) 63 (65.6) Ⅲ 34 (19.2) 21 (21.9) Unknown 10 (5.6) 9 (9.4) Pathological type 4.164 0.041 Invasive ductal carcinoma 172 (97.2) 88 (91.7) Others 5 (2.8) 8 (8.3) LVI 6.893 0.009 Negative 119 (67.2) 49 (51.0) Positive 58 (32.8) 47 (49.0) ER status 0.092 0.761 < 10% 34 (19.2) 17 (17.7) ≥ 10% 143 (80.8) 79 (82.3) PR status 0.026 0.872 < 10% 57 (32.2) 30 (31.3) ≥ 10% 120 (67.8) 66 (68.8) Ki-67 index 1.660 0.436 < 14% 52 (29.4) 24 (25.0) ≥ 14%, ≤ 30% 67 (37.9) 44 (45.8) > 30% 58 (32.8) 28 (29.2) Her2 status 0.180 0.672 Negative 135 (76.3) 71 (74.0) Positive 42 (23.7) 25 (26.0) Molecular type 3.426 0.489 Luminal A 65 (36.7) 27 (28.1) Luminal B-Her (-) 58 (32.8) 36 (37.5) Luminal B-Her2 (+) 22 (12.4) 17 (17.7) ERBB2 (+) 15 (8.5) 6 (6.3) Basal-like 17 (9.6) 10 (10.4) Tumor site 11.353 0.023 Upper outer 80 (45.2) 61 (63.5) Lower outer 22 (12.4) 13 (13.7) Lower inner 15 (8.5) 3 (3.2) Upper inner 45 (25.4) 13 (13.7) Central portion 15 (8.5) 6 (6.3) Multifocal lesions 2.513 0.113 No 169 (95.5) 87 (90.6) Yes 8 (4.5) 9 (9.4) Menstrual status 1.887 0.170 Premenopausal 102 (57.6) 47 (49.0) Postmenopausal 75 (42.4) 49 (51.0) Family history of malignancy 3.227 0.196 None 133 (75.1) 71 (74.0) Breast or ovarian cancer 16 (9.0) 4 (4.2) Other malignant tumors 28 (15.8) 21 (21.9) Table 2. Multivariate analysis of clinicopathological factors for nSLN metastasis Characteristic OR 95% CI P Value TS (mm) 1.051 1.019–1.084 0.002 Ratio of SLN macrometastases 12.597 4.302–36.890 0.0001 Tumor sites 0.054 Upper outer 1 reference Lower outer 0.777 0.344–1.754 0.544 Lower inner 0.255 0.066–0.980 0.047 Upper inner 0.405 0.193–0.853 0.017 Central portion 0.468 0.159–1.377 0.168 Table 3. Relationship between tumor size, ratio of SLN macrometastases and incidence of nSLN metastasis Characteristic Amount Incidence of nSLN metastasis TS > 22mm and ratio of SLN macrometastases > 0.33 53 73.6% TS > 22mm and ratio of SLN macrometastases ≤ 0.33 68 27.9% TS ≤ 22mm and ratio of SLN macrometastases > 0.33 70 32.9% TS ≤ 22mm and ratio of SLN macrometastases ≤ 0.33 82 17.1% In total 273 35.2% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Apr, 2023 Read the published version in World Journal of Surgical Oncology → Version 1 posted Editorial decision: Major revision 04 Nov, 2022 Reviews received at journal 09 Oct, 2022 Reviewers agreed at journal 06 Oct, 2022 Reviewers agreed at journal 06 Oct, 2022 Reviewers invited by journal 05 Oct, 2022 Editor assigned by journal 02 Oct, 2022 Submission checks completed at journal 27 Sep, 2022 First submitted to journal 22 Sep, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2091343\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":139844621,\"identity\":\"bc9d8695-1dfd-4d76-a6b2-600f501900c0\",\"order_by\":0,\"name\":\"Zhen Huang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhen\",\"middleName\":\"\",\"lastName\":\"Huang\",\"suffix\":\"\"},{\"id\":139844625,\"identity\":\"26d69a58-154a-4004-8148-373d054d9781\",\"order_by\":1,\"name\":\"Zhe Wu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhe\",\"middleName\":\"\",\"lastName\":\"Wu\",\"suffix\":\"\"},{\"id\":139844628,\"identity\":\"d7b64cc4-8a5a-461d-b5b6-73a4c33308ad\",\"order_by\":2,\"name\":\"Quan-qing Zou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Quan-qing\",\"middleName\":\"\",\"lastName\":\"Zou\",\"suffix\":\"\"},{\"id\":139844634,\"identity\":\"84434be9-170a-48ab-ac69-5443f8aed996\",\"order_by\":3,\"name\":\"Yu-jie Xie\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yu-jie\",\"middleName\":\"\",\"lastName\":\"Xie\",\"suffix\":\"\"},{\"id\":139844637,\"identity\":\"4c1a4448-8d62-4b27-b65d-eac8f46d1d8a\",\"order_by\":4,\"name\":\"Li-hui Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Li-hui\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":139844641,\"identity\":\"4ea6e8f8-2a90-4f75-bfd2-d390391e755a\",\"order_by\":5,\"name\":\"Yan-ping Huang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Fourth Affiliated Hospital of Guangxi Medical University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yan-ping\",\"middleName\":\"\",\"lastName\":\"Huang\",\"suffix\":\"\"},{\"id\":139844646,\"identity\":\"2625bb54-3dad-4945-9b12-02bacf602884\",\"order_by\":6,\"name\":\"Feng-ming Wu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Fourth Affiliated Hospital of Guangxi Medical University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Feng-ming\",\"middleName\":\"\",\"lastName\":\"Wu\",\"suffix\":\"\"},{\"id\":139844648,\"identity\":\"1cba9c43-d70c-4f27-bcef-5c966cc87f1f\",\"order_by\":7,\"name\":\"Dong Huang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Dong\",\"middleName\":\"\",\"lastName\":\"Huang\",\"suffix\":\"\"},{\"id\":139844649,\"identity\":\"65b7437e-a20c-46e1-8390-7efb835f76b4\",\"order_by\":8,\"name\":\"Yin-hua Pan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yin-hua\",\"middleName\":\"\",\"lastName\":\"Pan\",\"suffix\":\"\"},{\"id\":139844652,\"identity\":\"7287e672-28a3-497b-8282-32fa5663c925\",\"order_by\":9,\"name\":\"Jian-rong Yang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYDACCQYGZjCDmbHxQQWYwdxApBZ25maDMxC9xGrhZ2+TAGthIKBFfnbzsceFbXZ58s6MbRUHKg5H87cDtfyo2IZTC+OcY+nGM9uSiw0PM7bdOHAmLXfGYcYGxp4zt3FqYZbIMZPmbWNO3NjM2Hb7Y5tNbgNQCzOQjVMLm0T+N6CWerCWgoNtErnzCWnhkchhA2o5nDgfqIzhINCWDYS0SEikmUnznDueuIGZsVkC5JeNQC0H8flFfkbyM2mesurE+f3HH34AhljuvPOHDz74UYFbCxwYHEDiHMChCM26BqKUjYJRMApGwUgEAHYEWV4hBXn/AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jian-rong\",\"middleName\":\"\",\"lastName\":\"Yang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-09-22 06:44:31\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-2091343/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-2091343/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12957-023-02888-z\",\"type\":\"published\",\"date\":\"2023-04-06T20:22:39+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":27158834,\"identity\":\"94526101-9901-4051-9865-dbab59ea165c\",\"added_by\":\"auto\",\"created_at\":\"2022-09-29 22:18:44\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":108593,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eResearch flow chart. \\u003c/strong\\u003eTM, total mastectomy; SLNB, sentinel lymph node biopsy; ITCs, isolated tumor cell clusters; SLN, sentinel lymph node, ALND, axillary lymph node dissection; nSLN, non-sentinel lymph node.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2091343/v1/4d28c6efbf0bfe9343fd761c.png\"},{\"id\":27158836,\"identity\":\"8395d103-4bdd-47ba-a498-146e4e50ec70\",\"added_by\":\"auto\",\"created_at\":\"2022-09-29 22:18:44\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":114701,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eReceiver operating characteristic (ROC) analysis of tumor size. The ROC analysis identified a cut-off point of 22 mm (AUC 0.625, sensitivity 60.4%, specificity 64.4%, P \\u0026lt; 0.001).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.jpg.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2091343/v1/4edd1c98a3ccb1fcb6cccf12.png\"},{\"id\":27158835,\"identity\":\"4c599876-5a40-4022-a6d5-ee61dc0788cf\",\"added_by\":\"auto\",\"created_at\":\"2022-09-29 22:18:44\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":120333,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eReceiver operating characteristic (ROC) analysis of ratio of SLN macrometastases. The ROC analysis identified a cut-off point of 0.33 (AUC 0.680, sensitivity 64.6%, specificity 65.5%), P \\u0026lt; 0.001).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.jpg.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2091343/v1/8b8c807304ebe15fa19dbe6f.png\"},{\"id\":44724667,\"identity\":\"4c9ea727-9675-4875-8e2a-a62a04ec628b\",\"added_by\":\"auto\",\"created_at\":\"2023-10-16 20:33:01\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":644561,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2091343/v1/0f196890-c07b-4c72-abe1-afc5e0eac52e.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Risk factors of non-sentinel lymph node metastasis in breast cancer with 1–2 sentinel lymph node micrometastases: a case control study\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eIn recent years, with the continuous rising of incidence, breast cancer has become one of the most common malignant tumors harmful to women's health. The axillary lymph node dissection (ALND) used to be the standard treatment of axillary surgery for early breast cancer. However, the complications such as upper limb motor dysfunction, lymphedema, and sensory loss that may be caused by ALND seriously affect nearly 39% of postoperative patients [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eWith the application of sentinel lymph node biopsy (SLNB) and the support of its safety studies, the surgical management of the axillary in breast cancer patients has undergone major changes [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. For patients with cN\\u0026thinsp;+\\u0026thinsp;before surgery, ALND is still recommended. However, for patients with cN0, SLNB should be recommended as much as possible after being informed of its safety and possible risks to reduce the risk of postoperative complications. Among them, for patients with positive sentinel lymph node (SLN), according to the ACOSOG Z0011 study, it is safe and feasible to avoid ALND in patients with cT1/2N0 and 1\\u0026ndash;2 SLN positive (macro/micro metastases) who receive breast-conserving therapy (BCT) [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. For patients with cT1/2N0 and 1\\u0026ndash;2 SLN micrometastases who underwent total mastectomy (TM), ALND exemption can also be considered based on the results of the IBCSG 23\\u0026thinsp;\\u0026minus;\\u0026thinsp;01 study [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. For patients with cT1/2N0 and 1\\u0026ndash;2 SLN macrometastases who underwent TM, the EORTC AMAROS study supports the safe and feasible replacement of ALND by axillary radiotherapy (ART) [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. However, there is still insufficient evidence from clinical studies to support whether further axillary treatment including ALND or ART can be safely exempted.\\u003c/p\\u003e \\u003cp\\u003eIn previous studies, a variety of clinicopathological factors have been considered to be associated with non-sentinel lymph node (nSLN) metastasis in SLN-positive breast cancer [\\u003cspan additionalcitationids=\\\"CR7 CR8\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. This study will further explore the risk factors related to nSLN metastasis in patients under specific conditions with cT1/2N0 stage, undergoing TM and 1\\u0026ndash;2 SLN macrometastases. It is helpful for clinical identification of low-risk patients with nSLN metastasis under such conditions, so as to guide the treatment decision whether ALND or ART can be exempted.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003ePatients and data collection\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe clinicopathological data of patients with invasive breast cancer who underwent TM and SLNB in the People\\u0026apos;s Hospital of Guangxi Zhuang Autonomous Region and the Fourth Affiliated Hospital of Guangxi Medical University from January 2017 to February 2022 were retrospectively analyzed. SLN-positive patients\\u0026nbsp;underwent further\\u0026nbsp;ALND. The clinicopathological data included: age, BMI, total number of SLN, number of negative SLN, ratio of SLN macrometastases, preoperative neutrophil lymphocyte ratio (NLR), tumor size (TS), lymphovascular invasion (LVI), histological grade, human epidermal growth factor receptor-2 (HER2) status, estrogen receptor (ER) status, progesterone receptor (PR) status, Ki-67 index, pathological type, multifocal lesions, family history of malignancy and menstrual status, etc.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInclusion and exclusion criteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInclusion criteria:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;(1) Diagnosed with invasive breast cancer and received TM and axillary SLNB;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(2) TS \\u0026le; 5cm with cN0 (no palpable enlarged lymph nodes, no abnormal morphological and echoic lymph nodes were found on ultrasound) [10];\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(3) With 1\\u0026ndash;2 macrometastatic SLN and\\u0026nbsp;underwent\\u0026nbsp;ALND;\\u003c/p\\u003e\\n\\u003cp\\u003eExclusion criteria:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;(1) SLN was negative, only isolated tumor cell clusters or micrometastases, and \\u0026ge; 3 macrometastases were found during operation;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;(2) Received neoadjuvant therapy;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;(3) Incomplete clinicopathological data;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSLNB and ALND procedure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAfter anesthesia and disinfection, take 2 ml of 1% methylene blue were injected into the areola subcutaneously 5\\u0026ndash; 10 minutes before surgery. Blue-stained lymph nodes and their adjacent enlarged non-blue-stained lymph nodes were searched along the blue-stained lymphatic vessels as SLN and sent for intraoperative frozen pathological diagnosis. SLN-positive patients underwent further ALND. Axillary lymph nodes were routinely dissected at level I to II, and some patients were dissected to level III.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eJudgment criteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHistological grade [11]: Using the modified Scarff-Bloom-Richardson grading system: according to the proportion of glandular tube formation, cell atypia and mitotic count, each of the three indicators was independently assessed and given 1\\u0026ndash;3 points. The histological grade of invasive carcinoma was divided into grade Ⅰ (3\\u0026ndash;5 points), grade Ⅱ (6\\u0026ndash;7 points) and grade Ⅲ (8\\u0026ndash;9 points) according to the combined total score.\\u003c/p\\u003e\\n\\u003cp\\u003eTumor size: The pathological findings (gross and microscopic measurements) size of a primary tumor\\u0026nbsp;were the main results, combined with imaging modalities such as mammography, ultrasound, and MR imaging.\\u0026nbsp;For patients with intraductal carcinoma, the size of the invasion was the criterion.\\u003c/p\\u003e\\n\\u003cp\\u003eTypes of SLN metastasis: According to definitions of the American Joint Committee on Cancer (AJCC). ITCs is defined as small clusters of cells \\u0026le; 0.2 mm, or single tumor cells, or fewer than 200 cells in a single histologic cross-section. Micrometastasis is defined as tumor deposits \\u0026gt; 0.2 mm but \\u0026le; 2.0 mm in largest dimension. Macrometastasis is defined as tumor deposits \\u0026gt; 2.0 mm in largest dimension.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eRatio of SLN micrometastases: The ratio of the number of macrometastatic SLN to the total number of SLN.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe SPSS 23 Statistics software application was used to perform to determine risk factors. Chi-squared test was usually used for categorical data, while Students T test or Wilcoxon Rank Sum was used for continuous measurement data. Multivariate unconditional logistic regression analysis was used for multivariate correlation analysis. The diagnostic accuracy was assessed by receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) was used to evaluate the critical value of relevant factors. P \\u0026lt; 0.05 was considered to indicate a statistically significant difference.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003ePatients and treatments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 1,491 patients with invasive breast cancer underwent TM and SLNB, all of whom were female. Among them, patients with SLN 1\\u0026ndash;2 macrometastases accounted for 18.3% (n = 273), with an average age of 51.5 years.\\u0026nbsp;Pathological data after ALND showed that a total of 35.2% (n = 96) patients developed nSLN metastasis (Figure 1).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eUnivariate and multivariate analyses\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe comparison of clinicopathological factors showed that there were significant differences in total number of SLN, number of negative SLN, ratio of SLN macrometastases, TS, LVI, pathological type and tumor site between the nSLN-positive and nSLN-negative patients (P \\u0026lt; 0.05), while There was no significant difference between the two groups in age, BMI, NLR, histological grade, molecular type, ER status, PR status, Ki-67 index, HER2 status, multifocal lesions, menstrual status and family history of malignancy (Table 1).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe clinicopathological factors of total number of SLN, number of negative SLN,\\u0026nbsp;ratio of SLN macrometastases, TS, LVI, pathological types and tumor sites were included in multivariate analysis. The results indicated that TS (P = 0.002; OR: 1.051; 95% CI: 1.019\\u0026ndash;1.084) and Ratio of SLN macrometastases (P = 0.0001; OR: 12.597; 95% CI: 4.302\\u0026ndash;36.890) were the independent risk factors for nSLN metastasis in breast cancer with 1\\u0026ndash;2 SLN macrometastases undergoing TM (Table 2).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eROC analysis of TS and\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eratio of SLN macrometastases\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe cut-off points of TS and ratio of SLN macrometastases determined by receiver operating characteristic (ROC) analysis were 22mm (AUC 0.625, sensitivity 60.4%, specificity 64.4%, P\\u0026nbsp;\\u0026lt; 0.001, Figure 2) and 0.33 (AUC 0.680, sensitivity 64.6%, specificity 65.5%), P \\u0026lt; 0.001, Figure 3), respectively. When TS \\u0026gt; 22mm and ratio of SLN macrometastases\\u0026nbsp;\\u0026gt; 0.33, the incidence of nSLN metastasis was 73.6%, and when TS \\u0026le; 22mm and Ratio of SLN macrometastases \\u0026le; 0.33, the incidence of nSLN metastasis decreased to 17.1% (Table 3).\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn the comprehensive treatment of breast cancer, surgery still has an irreplaceable clinical status. With the gradual change of the treatment concept, the principle of surgical treatment has shifted from maximum tolerable treatment to minimum effective treatment. The SLNB technique has become a routine axillary treatment for patients with clinically node-negative breast cancer. For SLN-positive breast cancer patients, ALND is still the primary treatment [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. However, 34.3\\u0026ndash;77.3% of patients with SLN-positive were found to have no nSLN metastasis after ALND [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. With the announcement of the 10-year follow-up results of the ACOSOG Z0011 trial [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e] and the IBCSG 23\\u0026thinsp;\\u0026minus;\\u0026thinsp;01 trial [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e], TM with 1\\u0026ndash;2 SLN micrometastases and BCT with 1\\u0026ndash;2 SLN micro/macro metastases of breast cancer patients, it is safe to avoid ALND. However, whether patients with TM and 1\\u0026ndash;2 SLN macrometastases can be exempted from ALND is still insufficient evidence from clinical studies. Among this study, the patients with TM and 1\\u0026ndash;2 SLN macrometastases, 64.8% of the patients did not develop nSLN metastasis. Means that it did not benefit from having undergone ALND surgery. To explore the risk factors related to nSLN metastasis in patients undergoing TM and 1\\u0026ndash;2 SLN macrometastases, and screen the patients who can avoid ALND, which is of great significance to reduce the trauma caused by surgery.\\u003c/p\\u003e \\u003cp\\u003eThere have been many previous studies on the risk factors related to SLN-positive and nSLN metastasis in breast cancer, but few studies have focused on the conditions of TM with SLN macrometastases. Previous studies have found that the size of SLN metastases, extracapsular invasion of SLN, the number of positive and negative SLN, the ratio of positive SLN, TS, LVI, histological grade, NLR and other clinicopathological factors were all related to the occurrence of nSLN metastasis [\\u003cspan additionalcitationids=\\\"CR7 CR8\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. In the analysis of our group, under the conditions of cT1/2N0 and TM with 1\\u0026ndash;2 SLN macrometastases, we found that the total number of SLN, number of negative SLN, ratio of SLN macrometastases, TS, LVI, pathological type and tumor site were correlated with the occurrence of nSLN metastasis. Multivariate analysis further found that TS and ratio of SLN macrometastases were independent predictors of nSLN metastasis. When TS\\u0026thinsp;\\u0026gt;\\u0026thinsp;22mm and ratio of SLN macrometastases\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.33, the incidence of nSLN metastasis was 73.6%, and when TS\\u0026thinsp;\\u0026le;\\u0026thinsp;22mm and ratio of SLN macrometastases\\u0026thinsp;\\u0026le;\\u0026thinsp;0.33, the incidence of nSLN metastasis decreased to 17.1%. It is suggested that selecting a small tumor burden before surgery and increasing the number of SLN detected during surgery can improve the accuracy of negative prediction of nSLN. It has important reference value for evaluating whether to exempt ALND.\\u003c/p\\u003e \\u003cp\\u003eAlthough ALND is currently recommended for patients with SLN-positive breast cancer undergoing TM, the real-world data on SLN-positive disease without ALND are equally noteworthy. Among the entire study cohort of 4093 patients had T1/2N0M0 breast cancer with 1\\u0026ndash;2 SLN metastases and underwent TM. ALND rates decreased from 89.9% in 2010 to 55.5% in 2015. Rates decreased from 82\\u0026ndash;8% in patients with SLN micrometastases and from 93\\u0026ndash;63% in those with macrometastases. In multivariable analysis, factors associated with omission of ALND were pT1 status, older age, more SLN removed, fewer positive SLN, and SLN micrometastasis [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. In addition, in another study of 329 patients with 1\\u0026ndash;2 SLN metastases who underwent TM, 201 patients received ALND. Compared with patients who received SLNB alone, patients who received ALND were characterized by higher tumor grade and higher proportion of hormone receptor-negative. After a median follow-up of 51 months, there were no significant differences in OS and local recurrence rates between the two groups [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Kim and his colleagues observed 3632 breast cancer patients who underwent TM with 1\\u0026ndash;2 SLN metastases, of which 883 patients did not receive ALND. No difference in OS between the two groups at a median follow-up of 54 months [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. All the above data suggest that it appears to be safe to avoid ALND in breast cancer patients with TM and 1\\u0026ndash;2 SLN metastases when selecting appropriate low-risk cases.\\u003c/p\\u003e \\u003cp\\u003eThere have been several prospective controlled studies on whether axillary treatment can be exempted for patients with 1\\u0026ndash;2 SLN macrometastases undergoing TM. Among them, the SINODAR ONE study was a prospective noninferiority multicenter randomized study aimed at assessing the role of ALND in patients undergoing either BCT or TM for T1\\u0026ndash;2 breast cancer and presenting 1\\u0026ndash;2 SLN macrometastases. It was no significant differences in OS or RFS between ALND recipients and non-ALND recipients at a mean follow-up of 32 months in the 879 cases [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. However, the low proportion of patients who underwent TM (24.8%) and the short follow-up time in this study still cannot alone answer the question of whether breast cancer patients who underwent TM with 1\\u0026ndash;2 SLN macrometastases can be exempted from ALND. In addition, SENOMAC and POSNOC studies are still in progress. The SENOMAC study, a non-inferiority study largely follows the inclusion criteria of the ACOSOG Z0011 study, but allows the inclusion of T1\\u0026ndash;3 patients who undergoing TM. A total of 3500 patients are randomized 1:1 to either undergo ALND or not, and the primary endpoint is breast cancer-specific survival at 5 years [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. The POSNOC study is a randomised, multi-centre, non-inferiority trial, aimed to evaluate whether breast cancer patients with T1-2, 1\\u0026ndash;2 SLN macrometastases who undergoing TM or BCT without axillary treatment are non-inferior to ALND or ART. The sample size is 1900 and participants will be followed up for 5 years. The primary endpoint is axillary recurrence at 5 years. By June 2021, POSNOC study had completed 1866 cases [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. The results of the ACOSOG Z0011 and IBCSG 23\\u0026thinsp;\\u0026minus;\\u0026thinsp;01 studies have changed the previous breast cancer treatment strategy. We expect the new research results will lead to new treatment decisions. In the just-published SENOMAC study of health-related quality of life and arm morbidity after axillary surgery, 976 patients (501 in SLNB and 475 in ALND) were enrolled, found that arm morbidity was significantly worse affected by ALND than by SLNB one year after surgery. The results underline the importance of ongoing attempts to safely de-escalate axillary surgery [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study is a retrospective study. The subject of the study is the breast cancer patients with T1/2, cN0 and TM with 1\\u0026ndash;2 SLN macrometastases that had not yet been supported by the results of randomized controlled studies. The study comprehensively evaluated the influence of different clinicopathological factors on nSLN metastasis and further analyzed the role of related influencing factors. It has certain reference significance for choosing whether to exempt ALND in clinical practice. However, there are some uncontrolled research biases in this study, which may have a certain impact on the results. We look forward to more randomized controlled studies to evaluate the safety of ALND exclusion in breast cancer patients with T1/2, cN0 and TM with 1\\u0026ndash;2 SLN macrometastases.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003ethe breast cancer patients with cT1/2N0 stage, undergoing TM and 1\\u0026ndash;2 SLN macrometastases, the occurrence of nSLN metastasis is closely related to TS and the ratio of SLN macrometastases. when the TS\\u0026thinsp;\\u0026le;\\u0026thinsp;22mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, and whether ALND can be exempted deserves further exploration.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eTM, Total mastectomy\\u003c/p\\u003e\\n\\u003cp\\u003eBTC,\\u0026nbsp;Breast-conserving therapy\\u003c/p\\u003e\\n\\u003cp\\u003eSLN, Sentinel lymph node\\u003c/p\\u003e\\n\\u003cp\\u003enSLN, non-Sentinel lymph node\\u003c/p\\u003e\\n\\u003cp\\u003eSLNB, Sentinel lymph node biopsy\\u003c/p\\u003e\\n\\u003cp\\u003eALND, Axillary lymph node dissection\\u003c/p\\u003e\\n\\u003cp\\u003eART,\\u0026nbsp;Axillary radiotherapy\\u003c/p\\u003e\\n\\u003cp\\u003eNLR, Neutrophil lymphocyte ratio\\u003c/p\\u003e\\n\\u003cp\\u003eTS,\\u0026nbsp;Tumor size\\u003c/p\\u003e\\n\\u003cp\\u003eLVI, Lymphovascular invasion\\u003c/p\\u003e\\n\\u003cp\\u003eER, Estrogen receptor\\u003c/p\\u003e\\n\\u003cp\\u003ePR,\\u0026nbsp;Progesterone receptor\\u003c/p\\u003e\\n\\u003cp\\u003eHER2, Human epidermal growth factor receptor-2\\u003c/p\\u003e\\n\\u003cp\\u003eROC, Receiver operating characteristic\\u003c/p\\u003e\\n\\u003cp\\u003eAUC, The area under the ROC curve\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval and consent to participate\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the Institutional Ethics Review Board of the People\\u0026apos;s Hospital of Guangxi Zhuang Autonomous Region and the Fourth Affiliated Hospital of Guangxi Medical University.\\u003c/p\\u003e\\n\\u003cp\\u003eConsent for publication\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data and materials\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003eCompeting interests\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests\\u003c/p\\u003e\\n\\u003cp\\u003eFunding\\u003c/p\\u003e\\n\\u003cp\\u003eThis study received funding from\\u0026nbsp;Guangxi Zhuang Autonomous Region Health Commission Self-funded scientific research project (Z20200134)\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; contributions\\u003c/p\\u003e\\n\\u003cp\\u003eJRY: study conception and design, interpretation of results; ZH: study conception and design, data collection and analysis, draft manuscript preparation; ZW and YJX：data collection and analysis, draft manuscript preparation; LHL, YPH, FMW, DH, and YHP: data collection. All authors approved the final version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003eAcknowledgements\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; information\\u003c/p\\u003e\\n\\u003cp\\u003eJian-rong Yang: Department of Surgery, People\\u0026apos;s Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530021, China, E-mail: zhenhuang11@foxmail.com\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003ePusic AL, Cemal Y, Albornoz C, et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv. 2013;7:83\\u0026ndash;92.\\u003c/li\\u003e\\n\\u003cli\\u003eWong W, Rubenchik I, Nofech-Mozes S, et al. Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy. Technol Cancer Res Treat. 2019;01:1\\u0026ndash;6.\\u003c/li\\u003e\\n\\u003cli\\u003eGiuliano AE, Ballman K, McCall L, et al. Locoregional Recurrence After Sentinel Lymph Node Dissection with or Without Axillary Dissection in Patients with Sentinel Lymph Node Metastases: Long-term Follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial. Ann Surg. 2016;264:413\\u0026ndash;420.\\u003c/li\\u003e\\n\\u003cli\\u003eGalimberti V, Cole BF, Viale G. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol. 2018;19:1385\\u0026ndash;1393.\\u003c/li\\u003e\\n\\u003cli\\u003eSandoughdaran S, Malekzadeh M, Mohammad Esmaeil ME. Frequency and Predictors of Axillary Lymph Node Metastases in Iranian Women with Early Breast Cancer. Asian Pac J Cancer Prev. 2018;19:1617\\u0026ndash;1620.\\u003c/li\\u003e\\n\\u003cli\\u003evan la Parra RF, Peer PG, Ernst MF, et al. Meta-analysis of predictive factors for non-sentinel lymph node metastases in breast cancer patients with a positive SLN. Eur J Surg Oncol. 2011;37:290\\u0026ndash;299.\\u003c/li\\u003e\\n\\u003cli\\u003eIbrahim A, Serkan YF, Tuba A, et al. Can Neutrophil to Lymphocyte Ratio Be a Predictor Tool for The Non-Sentinel Lymph Node Metastasis in Breast Cancer? Chirurgia (Bucur). 2019;114:83\\u0026ndash;88.\\u003c/li\\u003e\\n\\u003cli\\u003eWang XY, Wang JT, Guo T, et al. Risk factors and a predictive nomogram for non-sentinel lymph node metastases in Chinese breast cancer patients with one or two sentinel lymph node macrometastases and mastectomy. Curr Oncol. 2019;26:210\\u0026ndash;215.\\u003c/li\\u003e\\n\\u003cli\\u003eZhou Y, Huang X, Mao F, et al. Predictors of nonsentinel lymph node metastasis in patients with breast cancer with metastasis in the sentinel node. Medicine (Baltimore). 2019;98:1\\u0026ndash;7.\\u003c/li\\u003e\\n\\u003cli\\u003eZheng J, Cai S, Song H, et al. Positive non-sentinel axillary lymph nodes in breast cancer with 1\\u0026ndash;2 sentinel lymph node metastases. Medicine (Baltimore). 2018;97:1\\u0026ndash;6.\\u003c/li\\u003e\\n\\u003cli\\u003eBansal C, Pujani M, Sharma KL, et al. Grading systems in the cytological diagnosis of breast cancer: a review. J Cancer Res Ther. 2014;10:839\\u0026ndash;845.\\u003c/li\\u003e\\n\\u003cli\\u003eGipponi M, Bassetti C, Canavese G, et al. Sentinel lymph node as a new marker 407 for therapeutic planning in breast cancer patients. J Surg Oncol. 2004;85:102\\u0026ndash;111.\\u003c/li\\u003e\\n\\u003cli\\u003eHennigs A, Riedel F, Fei\\u0026szlig;t M, et al. Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study[J]. Ann Surg Oncol. 2019;26:2435\\u0026ndash;2443.\\u003c/li\\u003e\\n\\u003cli\\u003eSun J, Mathias BJ, Laronga C, et al. Impact of Axillary Dissection Among Patients with Sentinel Node-Positive Breast Cancer Undergoing Mastectomy. J Natl Compr Canc Netw. 2021;19:40\\u0026ndash;47.\\u003c/li\\u003e\\n\\u003cli\\u003eKim BK, Park BW, Hur MH, et al. Omission of axillary lymph node dissection in patients who underwent total mastectomy with 1 or 2 metastatic lymph nodes. Ann Surg Treat Res. 2020;98:283\\u0026ndash;290.\\u003c/li\\u003e\\n\\u003cli\\u003eTinterri C, Gentile D, Gatzemeier W, et al. Preservation of Axillary Lymph Nodes Compared with Complete Dissection in T1-2 Breast Cancer Patients Presenting One or Two Metastatic Sentinel Lymph Nodes: The SINODAR-ONE Multicenter Randomized Clinical Trial. ANN SURG ONCOL, 2022;29:5732\\u0026ndash;5744.\\u003c/li\\u003e\\n\\u003cli\\u003ede Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer. 2017;17:379.\\u003c/li\\u003e\\n\\u003cli\\u003eGoyal A, Mann GB, Fallowfield L, et al. POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes. BMJ Open. 2021;11: e054365.\\u003c/li\\u003e\\n\\u003cli\\u003eAppelgren M, Sackey H, Wengstr\\u0026ouml;m Y, et al. Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial. Breast. 2022;01:16\\u0026ndash;23.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1.\\u0026nbsp;\\u003c/strong\\u003eRelationship between nSLN and clinicopathological factors\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\" summary=\\\"\\\" width=\\\"90%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eCharacteristic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003enSLN-negative (n = 177)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003enSLN-positive (n = 96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003et/z/x\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge at diagnosis (year)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e51.24 \\u0026plusmn; 10.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e51.89 \\u0026plusmn; 11.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-0.466\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.642\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e23.31 (21.24\\u0026ndash;25.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e23.12 (21.40\\u0026ndash;26.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-0.707\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.480\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTS\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;(mm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e20 (15\\u0026ndash;25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e25 (20\\u0026ndash;30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-3.429\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal number of SLN\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e4 (3\\u0026ndash;5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e3 (2\\u0026ndash;4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-2.937\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;Number of negative SLN\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e2.00 (1.00\\u0026ndash;4.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e1.50 (0.25\\u0026ndash;3.00)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-3.959\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRatio of SLN macrometastases\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e0.33 (0.25\\u0026ndash;0.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e0.50 (0.33\\u0026ndash;0.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-4.987\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNLR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e1.99 (1.61\\u0026ndash;2.68)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e2.00 (1.53\\u0026ndash;2.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e-0.803\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.423\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHistological grade\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e6.428\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.093\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eⅠ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e20 (11.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e3 (3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eⅡ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e113 (63.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e63 (65.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eⅢ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e34 (19.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e21 (21.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eUnknown\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e10 (5.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e9 (9.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePathological type\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e4.164\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.041\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eInvasive ductal carcinoma\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e172 (97.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e88 (91.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eOthers\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e5 (2.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e8 (8.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLVI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e6.893\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.009\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eNegative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e119 (67.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e49 (51.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003ePositive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e58 (32.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e47 (49.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eER status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e0.092\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.761\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 10%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e34 (19.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e17 (17.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge; 10%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e143 (80.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e79 (82.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePR status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e0.026\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.872\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 10%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e57 (32.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e30 (31.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge; 10%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e120 (67.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e66 (68.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eKi-67 index\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e1.660\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.436\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 14%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e52 (29.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e24 (25.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge; 14%, \\u0026le; 30%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e67 (37.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e44 (45.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt; 30%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e58 (32.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e28 (29.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHer2 status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e0.180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.672\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eNegative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e135 (76.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e71 (74.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003ePositive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e42 (23.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e25 (26.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMolecular type\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e3.426\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.489\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eLuminal A\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e65 (36.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e27 (28.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eLuminal B-Her (-)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e58 (32.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e36 (37.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eLuminal B-Her2 (+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e22 (12.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e17 (17.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eERBB2 (+)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e15 (8.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e6 (6.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eBasal-like\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e17 (9.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e10 (10.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTumor site\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e11.353\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.023\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eUpper outer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e80 (45.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e61 (63.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eLower outer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e22 (12.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e13 (13.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eLower inner\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e15 (8.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e3 (3.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eUpper inner\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e45 (25.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e13 (13.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eCentral portion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e15 (8.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e6 (6.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMultifocal lesions\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e2.513\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.113\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e169 (95.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e87 (90.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e8 (4.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e9 (9.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMenstrual status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e1.887\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.170\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003ePremenopausal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e102 (57.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e47 (49.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003ePostmenopausal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e75 (42.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e49 (51.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFamily history of malignancy\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\n \\u003cp\\u003e3.227\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\n \\u003cp\\u003e0.196\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e133 (75.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e71 (74.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eBreast or ovarian cancer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e16 (9.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e4 (4.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"28.8659793814433%\\\"\\u003e\\n \\u003cp\\u003eOther malignant tumors\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"30.927835051546392%\\\"\\u003e\\n \\u003cp\\u003e28 (15.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"20.61855670103093%\\\"\\u003e\\n \\u003cp\\u003e21 (21.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.34020618556701%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"8.24742268041237%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2.\\u0026nbsp;\\u003c/strong\\u003eMultivariate analysis of clinicopathological factors for nSLN metastasis\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\" width=\\\"80%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003eCharacteristic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003eOR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e95% CI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTS (mm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e1.051\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e1.019\\u0026ndash;1.084\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.002\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRatio of SLN macrometastases\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e12.597\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e4.302\\u0026ndash;36.890\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.0001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTumor sites\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.054\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003eUpper outer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003ereference\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003eLower outer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e0.777\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e0.344\\u0026ndash;1.754\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.544\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003eLower inner\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e0.255\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e0.066\\u0026ndash;0.980\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.047\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003eUpper inner\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e0.405\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e0.193\\u0026ndash;0.853\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"35.05154639175258%\\\"\\u003e\\n \\u003cp\\u003eCentral portion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"19.587628865979383%\\\"\\u003e\\n \\u003cp\\u003e0.468\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"23.711340206185568%\\\"\\u003e\\n \\u003cp\\u003e0.159\\u0026ndash;1.377\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"21.649484536082475%\\\"\\u003e\\n \\u003cp\\u003e0.168\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3.\\u0026nbsp;\\u003c/strong\\u003eRelationship between tumor size, ratio of SLN macrometastases and incidence of nSLN metastasis\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"56.02536997885835%\\\"\\u003e\\n \\u003cp\\u003eCharacteristic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.050739957716702%\\\"\\u003e\\n \\u003cp\\u003eAmount\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"31.923890063424945%\\\"\\u003e\\n \\u003cp\\u003eIncidence of nSLN metastasis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"56.02536997885835%\\\"\\u003e\\n \\u003cp\\u003eTS \\u0026gt; 22mm and ratio of SLN macrometastases \\u0026gt; 0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.050739957716702%\\\"\\u003e\\n \\u003cp\\u003e53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"31.923890063424945%\\\"\\u003e\\n \\u003cp\\u003e73.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"56.02536997885835%\\\"\\u003e\\n \\u003cp\\u003eTS \\u0026gt; 22mm and ratio of SLN macrometastases \\u0026le; 0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.050739957716702%\\\"\\u003e\\n \\u003cp\\u003e68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"31.923890063424945%\\\"\\u003e\\n \\u003cp\\u003e27.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"56.02536997885835%\\\"\\u003e\\n \\u003cp\\u003eTS \\u0026le; 22mm and ratio of SLN macrometastases \\u0026gt; 0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.050739957716702%\\\"\\u003e\\n \\u003cp\\u003e70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"31.923890063424945%\\\"\\u003e\\n \\u003cp\\u003e32.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"56.02536997885835%\\\"\\u003e\\n \\u003cp\\u003eTS \\u0026le; 22mm and ratio of SLN macrometastases \\u0026le; 0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.050739957716702%\\\"\\u003e\\n \\u003cp\\u003e82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"31.923890063424945%\\\"\\u003e\\n \\u003cp\\u003e17.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"56.02536997885835%\\\"\\u003e\\n \\u003cp\\u003eIn total\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.050739957716702%\\\"\\u003e\\n \\u003cp\\u003e273\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"31.923890063424945%\\\"\\u003e\\n \\u003cp\\u003e35.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"world-journal-of-surgical-oncology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"wjso\",\"sideBox\":\"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)\",\"snPcode\":\"12957\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12957/3\",\"title\":\"World Journal of Surgical Oncology\",\"twitterHandle\":\"@OncoBioMed\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Breast cancer, Total mastectomy, Sentinel lymph node, Macrometastasis, non-Sentinel lymph node, Risk factor\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2091343/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2091343/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackgrround\\u003c/h2\\u003e\\n\\u003cp\\u003eThe randomized trials include ACOSOG Z0011 and IBCSG 23 − 01 had found that, the survival rates were not different in patients with cT1/2N0 and 1–2 sentinel lymph node (SLN) positive, macro/micro metastases who underwent breast-conserving therapy and micrometastases who underwent total mastectomy (TM), when axillary lymph node dissection (ALND) was omitted. However, for patients with cT1/2N0 and 1–2 SLN macrometastases who underwent TM, there was no published clinical research evidence whether ALND can be exempted. This study aimed to investigate the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1–2 SLN macrometastases undergoing TM.\\u003c/p\\u003e\\n\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\n\\u003cp\\u003eThe clinicopathological data of 1491 breast cancer patients underwent TM and SLNB from January 2017 to February 2022 were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for nSLN metastasis.\\u003c/p\\u003e\\n\\u003ch2\\u003eResults\\u003c/h2\\u003e\\n\\u003cp\\u003eA total of 273 patients with 1–2 SLN macrometastases underwent TM were enrolled. Postoperative pathological data showed that 35.2% patients had nSLN metastasis. The results of multivariate analysis indicated that tumor size (TS) (P = 0.002; OR: 1.051; 95% CI: 1.019–1.084) and ratio of SLN macrometastases (P = 0.0001; OR: 12.597: 95% CI: 4.302–36.890) were the independent risk factors for nSLN metastasis in breast cancer with 1–2 SLN macrometastases underwent TM. The ROC curve analysis suggested that when TS ≤ 22mm and ratio of SLN macrometastases ≤ 0.33, the incidence of nSLN metastasis could be reduced to 17.1%.\\u003c/p\\u003e\\n\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\n\\u003cp\\u003eThe breast cancer patients with cT1/2N0 stage, undergoing TM and 1–2 SLN macrometastases, when the TS ≤ 22mm and macrometastatic SLN does not exceed 1/3 of the total number of detected SLN, the incidence of nSLN metastasis is significantly reduced, and whether ALND can be exempted deserves further exploration.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Risk factors of non-sentinel lymph node metastasis in breast cancer with 1–2 sentinel lymph node micrometastases: a case control study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-09-29 22:18:42\",\"doi\":\"10.21203/rs.3.rs-2091343/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Major revision\",\"date\":\"2022-11-04T04:34:09+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2022-10-09T17:33:33+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"21fbb482-810d-48d8-9cc7-0383dfcfe069\",\"date\":\"2022-10-06T19:39:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"52e7c4c0-4978-4914-b929-87a3b79a36f7\",\"date\":\"2022-10-06T05:30:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2022-10-05T14:20:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2022-10-02T05:19:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2022-09-27T04:06:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"World Journal of Surgical Oncology\",\"date\":\"2022-09-22T06:42:29+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"world-journal-of-surgical-oncology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"wjso\",\"sideBox\":\"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)\",\"snPcode\":\"12957\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12957/3\",\"title\":\"World Journal of Surgical Oncology\",\"twitterHandle\":\"@OncoBioMed\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ead94831-ef2d-4adb-a7eb-082cd7b94617\",\"owner\":[],\"postedDate\":\"September 29th, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-10-16T20:29:22+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-2091343\",\"link\":\"https://doi.org/10.1186/s12957-023-02888-z\",\"journal\":{\"identity\":\"world-journal-of-surgical-oncology\",\"isVorOnly\":false,\"title\":\"World Journal of Surgical Oncology\"},\"publishedOn\":\"2023-04-06 20:22:39\",\"publishedOnDateReadable\":\"April 6th, 2023\"},\"versionCreatedAt\":\"2022-09-29 22:18:42\",\"video\":\"\",\"vorDoi\":\"10.1186/s12957-023-02888-z\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12957-023-02888-z\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2091343\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2091343\",\"identity\":\"rs-2091343\",\"version\":[\"v1\"]},\"buildId\":\"zQwnuV7TCBrMSSSToR1PI\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}