Retrospective Analysis of Predictive Factors for Axillary Non-Sentinel LymphNode Metastases in Sentinel Node-Positive Early-Stage Breast Cancer Patients
Vedad Dedic1, Timur Ceric2, Sadat Pusina1, Mirhan Salibasic1, Nejra Selak3, Nedim Katica4, Nerman Kaknjasevic1
1 Department of General, Abdominal and Glandular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
2 Department of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
3 Department of Pathology, Clinical Center University of Tuzla, Tuzla, Bosnia and Herzegovina
4 Department of Plastic and Reconstructive Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Corresponding Author: Vedad Dedic MD. Department of General, Abdominal and Glandular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina; E-mail: dedicvedad7@gmail.com; Phone:+387 62 634-346; ORCID ID: https://orcid.org/0000-0002-1104-0943
Cite this article: Dedic V, Ceric T, Pusina S, Salibasic M, Selak N, Katica N, et al. Retrospective Analysis of Pre-dictive Factors for Axillary Non-Sentinel Lymph Node Metastases in Sentinel Node-Positive Early-Stage Breast Cancer Patients. Sar Med J. 2025; 2(1):20-25. 
10.70119/0031-25
Pages: 20 – 25/ Published online: 20 June 2025
Original submission: 19 March 2025; Revised submission: 16 May 2025; Accepted: 25 May 2025
Abstract
Introduction. Sentinel lymph node biopsy (SLNB) has signifi cantly advanced axillary staging in clinically node-negative breast cancer, off ering lower morbidity compared to traditional axi-llary lymph node dissection (ALND). Nonetheless, precise prediction of non-sentinel lymph node (non-SLN) involvement remains essential for optimizing surgical decisions and preventing unne-cessary ALND.
Methods. A retrospective cohort analysis was performed on 176 patients with clinically node-negative breast cancer who underwent SLNB. Clinicopathological data were reviewed to evaluate associations between various predictive factors and non-SLN involvement. Variables analyzed included tumor size, histological grade, lymphovascular invasion (LVI), Ki-67 proliferation index, and sentinel lymph node characteristics.
Results. Multivariable logistic regression identifi ed the type of SLN metastasis (OR=21.4; 95% CI 1.7–43.6; p=0.01), the number of positive SLNs (OR=5.66; 95% CI 1.18–36.6; p=0.03), and the number of negative SLNs (OR=0.04; 95% CI 0.006–0.27; p=0.001) as independent predictors of non-SLN metastases. The predictive model demonstrated excellent discriminatory power, with an area under the receiver operating characteristic curve (AUC) of 0.91.
Conclusion. Specifi c clinical and histopathological variables reliably predict non-SLN involve-ment in SLN-positive breast cancer patients. Incorporation of these predictors into clinical prac-tice may enhance individualized axillary management and reduce unnecessary ALND procedures. Further validation through larger prospective studies is warranted.
Keywords: Breast Neoplasms, Sentinel Lymph Node Biopsy, Axillary Lymph Nodes, Lymph Node Dissection, Neoplasm Staging.
