Assessing the Clinical Efficacy and Effectiveness of Sentinel Lymph Node Biopsy Combined with Breast-Conserving Surgery for Early-Stage Breast Cancer

Objective:To analyze the impact of sentinel lymph node biopsy(SLNB)combined with breast-conserving surgery in the clinical treatment of early-stage breast cancer.Methods:80 patients with early-stage breast cancer admitted to the Second Department of Breast Surgery at Dezhou Second People’s Hospital from September 2020 to September 2022 were selected and randomly divided into a control group and an observation group using the random number table method,with 40 cases in each group.The control group underwent a modified radical mastectomy,while the observation group underwent SLNB combined with breast-conserving surgery.The surgical efficacy and prognosis between the two groups were compared.Results:The observation group exhibited shorter operation,hospitalization,and extubation times,as well as less intraoperative blood loss and drainage volume,all of which were significantly better than those in the control group(P<0.05).Additionally,the observation group demonstrated a higher rate of excellent breast cosmetology and quality of life,with lower complication incidence,significantly outperforming the control group(P<0.05).There was no statistical difference in the metastasis rate and recurrence rate between the two groups(P>0.05).Conclusion:The combination of SLNB and breast-conserving surgery proves highly effective for patients with early-stage breast cancer,presenting fewer complications and enhancing both breast cosmetic outcomes and quality of life.

Prospective study found that peripheral lymph node sampling reduced the false-negative rate of sentinel lymph node biopsy for breast cancer

Background:Although sentinel lymph node biopsy(SLNB) can accurately predict the status of axillary lymph node(ALN) metastasis,the high false?negative rate(FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection(ALND).The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node(PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of "skip metastasis" on the FNR of SLNB.Methods:At Shandong Cancer Hospital Affiliated to Shandong University between March 1,2012 and June 30,2015,the sentinel lymph nodes(SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer.First,the SLNs were removed;then,the area surrounding the original SLNs was selected,and the visible lymph nodes in a field of 3–5 cm in diameter around the center(i.e.,PLNs) were removed,avoiding damage to the structure of the breast.Finally,ALND was performed.The SLNs,PLNs,and remaining ALNs underwent pathologic examination,and the relationship between them was analyzed.Results:The identification rate of SLNs in the 596 patients was 95.1%(567/596);the metastasis rate of ALNs was 33.7%(191/567);the FNR of pure SLNB was 9.9%(19/191);and after the SLNs and PLNs were eliminated,the FNR was 4.2%(8/191),which was significantly decreased compared with the FNR before removal of PLNs(P Aected number(N) of SLNs,the patients were divided into four groups of N = 0.028).ccording to the det= 1,2,3,and ≥4;the FNR in these groups was 19.6,9.8,7.3,and 2.3%,respectively.For the patients with removal of PLNs was significantly decreased compared with that before remo≤2 or val of P≤3 detected SLNs,the FNR afterLNs(N 3:12.2% vs.4.7%,P ≤ 2:14.0% vs.4.7%,P = 0.019;N ≤ nt(P = 0.021),whereas for patients with ≥4 detected SLNs,the decrease in FNR was not statistically significa= 1.000).In the entire cohorts,the "skip metastasis" rate was 2.5%(15/596);the FNR caused by "skip metastasis" was 2.1%(4/191).Conclusions:The FNR of SLNB was associated with the number of SLNs.For patients with mpling can reduce the FNR of SLNB to an acceptable level of less than 5%.Because of the≤3 detected SLNs,PLN sa existence of the "skip metastasis" and distinct metastasis patterns,the FNR of SLNB cannot be completely eliminated.

Feasibility of sentinel lymph node biopsy omission after integration of ^(18)F-FDG dedicated lymph node PET in early breast cancer: a prospective phase II trial

Objective:Sentinel lymph node biopsy(SLNB)is currently the standard of care in clinically node negative(cN0)breast cancer.The present study aimed to evaluate the negative predictive value(NPV)of 18F-FDG dedicated lymph node positron emission tomography(LymphPET)in cN0 patients.Methods:This was a prospective phase II trial divided into 2 stages(NCT04072653).In the first stage,cN0 patients underwent axillary LymphPET followed by SLNB.In the second stage,SLNB was omitted in patients with a negative preoperative axillary assessment after integration of LymphPET.Here,we report the results of the first stage.The primary outcome was the NPV of LymphPET to detect macrometastasis of lymph nodes(LN-macro).Results:A total of 189 patients with invasive breast cancer underwent LymphPET followed by surgery with definitive pathological reports.Forty patients had LN-macro,and 16 patients had only lymph node micrometastasis.Of the 131 patients with a negative LymphPET result,16 patients had LN-macro,and the NPV was 87.8%.After combined axillary imaging evaluation with ultrasound and LymphPET,100 patients were found to be both LymphPET and ultrasound negative,9 patients had LN-macro,and the NPV was 91%.Conclusions:LymphPET can be used to screen patients to potentially avoid SLNB,with an NPV>90%.The second stage of the SOAPET trial is ongoing to confirm the safety of omission of SLNB according to preoperational axillary evaluation integrating LymphPET.

Breast-conserving surgery and sentinel lymph node biopsy for breast cancer and their correlation with the expression of polyligand proteoglycan-1

BACKGROUND Breast cancer is a malignant tumor with an unclear etiology and is the most common malignant tumor in women.Surgery is the main clinical treatment for breast cancer.Although traditional total mastectomy combined with axillary lymph node dissection is effective,it can result in shoulder dysfunction,especially in middle-aged and elderly patients with breast cancer with weak constitution and other underlying diseases.Furthermore,the postoperative quality of life is poor.AIM To assess breast-conserving surgery and sentinel lymph node biopsy for breast cancer treatment and their correlation with polyligand proteoglycan-1.METHODS Overall,80 patients with breast cancer treated in our hospital from January 2021 to July 2021 were retrospectively selected and divided into an observation group(n=44)and control group(n=36)according to the treatment plan.The observation group was treated with breast-conserving surgery and sentinel lymph node biopsy,and the control group was treated with total breast resection.Simultaneously,immunohistochemical staining was used to detect the expression of syndecan-1(SDC-1)in the lesions,and its relationship with clinicopathological findings was analyzed.RESULTS Intraoperative blood loss,operation time,and hospital stay in the observation group were 65.51±9.94 m L,65.59±9.40 min,and 14.80±3.03 d,respectively,which were significantly lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 11.36%,which was significantly lower than that in the control group(P<0.05).The positive expression rate of SDC-1 in the observation group was 25.00%,and there was no significant difference between the groups(P>0.05).The positive expression rate of SDC-1 in patients with American Joint Committee on Cancer(AJCC)stageⅡwas 14.29%,which was significantly lower than that in patients with AJCC stageⅠ(P<0.05).The positive expression of SDC-1 had no significant relationship with age,course of disease,site,tissue type,and treatment plan(P>0.05).CONCLUSION Breast preservation surgery and sentinel lymph node biopsy for breast cancer treatment have fewer complications and quicker recovery than those treated with total breast resection.Low SDC-1 expression in breast cancer lesions is related to AJCC staging.

Recent Advances in the Tracer Technology Used for Sentinel Lymph Node Biopsy in Breast Cancer

The high incidence of breast cancer poses one of the greatest risks to female health worldwide. Sentinel lymph node biopsy (SLNB) is the standard of treatment for patients with axillary lymph node-negative early-stage breast cancer. Herein, the precise use of tracers is the key to ensuring the success of SLNB. However, owing to select-few limitations of traditional tracers, their clinical application is limited. New tracer techniques, such as the near-infrared fluorescent dye method (using indocyanine green), contrast-enhanced ultrasound, and superparamagnetic iron oxide nanoparticles are being applied in clinical practice. In this paper, we review the recent progress in SLNB tracer technology.

Diagnostic biopsy of cutaneous melanoma, sentinel lymph node biopsy and indications for lymphadenectomy

The incidence of cutaneous melanoma appears to be increasing worldwide and this is attributed to solar radiation exposure.Early diagnosis is a challenging task.Any clinically suspected lesion must be assessed by complete diagnostic excision biopsy(margins 1-2 mm);however,there are other biopsy techniques that are less commonly used.Melanomas are characterized by Breslow thickness as thin(<1 mm),intermediate(1-4 mm)and thick(>4 mm).This thickness determines their biological behavior,therapy,prognosis and survival.If the biopsy is positive,a wide local excision(margins 1-2 cm)is finally performed.However,metastasis to regional lymph nodes is the most accurate prognostic determinant.Therefore,sentinel lymph node biopsy(SLNB)for diagnosed melanoma plays a pivotal role in the management strategy.Complete lymph node clearance has undoubted advantages and is recommended in all cases of positive SLN biopsy.A PET-CT(positron emission tomography-computed tomography)scan is necessary for staging and follow-up after treatment.Novel targeted therapies and immunotherapies have shown improved outcomes in advanced cases.

Effect of Breast Conserving Sentinel Lymph Node Biopsy(SLNB)and Modified Radical Mastectomy on Patients with Early Breast Cancer

Objective:To study the clinical effect of breast conserving combined with sentinel lymph node biopsy and modified radical mastectomy in patients with early breast cancer.Methods:Female patients with early breast cancer in clinical stage I and II were selected as the main objects of this study,the study period started from July 2017 to July 2020.In the breast conserving and sentinel lymph node biopsy patients,50 cases were randomly selected as the experimental group;50 cases in the modified radical mastectomy patients were randomly selected as the control group.The clinical intervention effect of the two groups was analyzed.Results:the perioperative indexes of the experimental group were shorter than those of the control group,the patients recovered faster,the incidence of complications in the experimental group was lower,and the quality of life scores of the experimental group were significantly higher than those of the control group,and the difference was statistically significant,the intervention effect of the experimental group was also better.Conclusion:The application of breast conserving and sentinel lymph node biopsy in the treatment of early breast cancer can promote the recovery of patients,shorten the operation time and reduce the rate of complications,which has significant clinical significance.

A mini-review on factors and countermeasures associated with false-negative sentinel lymph node biopsies in breast cancer

Sentinel lymph node biopsy （SLNB） is a new surgical technique for local axillary lymph nodes （ALNs） of breast cancer. Large-scale clinical trials have confirmed that undergoing SLNB and ALN dissection （ALND） showed no significant difference for sentinel lymph node （SLN）-negative patients in terms of disease-free survival, overall survival and recurrence-free survival. However, false-negative results are still the main concern of physicians as well as patients who undergo SLNB instead of ALND. The American Society of Breast Surgeons established a task force to suggest acceptable standards for SLNB. In 2000, the task force recommended that the identification rate for SLNB be 85% or higher and the false-negative rate be 5% or lower. This review focuses on clinical factors （tumor volume, multifocal/multi-center cancers, neoadjuvant chemotherapy and skip metastasis）, tracer techniques and pathological factors affecting SLNB and explores methods for reducing the false-negative rate.

Macrometastasis at selective lymph node biopsy:A practical goingfor-the-one clinical scoring system to personalize decision making

BACKGROUND Axillary sentinel lymph node biopsy(SLNB)is standard treatment for patients with clinically and pathological negative lymph nodes.However,the role of completion axillary lymph node dissection(cALND)following positive sentinel lymph node biopsy(SLNB)is debated.AIM To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of longterm complications and create a Preoperative Clinical Risk Index(PCRI)that helps us in our clinical practice to optimize the selection of these patients.METHODS Patients with positive SLNB who underwent a cALND were included in this study.Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND.RESULTS From May 2007 to April 2014,we performed 1140 SLN biopsies,of which 125 were positive for tumor and justified to practice a posterior cALND.Pathologic findings at SLNB were micrometastases(mic)in 29 cases(23.4%)and macrometastasis(MAC)in 95 cases(76.6%).On univariate analysis of the 95 patients with MAC,statistically significant factors included:age,grade,phenotype,histology,lymphovascular invasion,lymph-node tumor size,and number of positive SLN.On multivariate analysis,only lymph-node tumor size(≤20 mm)and number of positive SLN(>1)retained significance.A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND.Patients with a PCRI≤15 has low probability(<10%)of having additional lymph node involvement,a PRCI between 15-17.6 has a probability of 43%,and the probability increases to 69%in patients with a PCRI>17.6.CONCLUSION The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND.Further prospective studies are necessary to validate PCRI clinical generalization.

SENTINEL NODE BIOPSY BY TWO KINDS OF BLUE DYES IN PATIENTS WITH BREAST CANCER

Objective To evaluate the identification successful rate of sentinel lymph node with breast cancer and the accuracy to predict axillary lymph node status in different vital blue dyes.Methods 94 patients with breast cancer were recruited for the study between Oct. 1999 and Apr. 2001, of whom 32 and 62, respectively, were injected 0.028mmol·L -1 Methylene blue and 0.018mmol·L -1 Patent blue violet in breast parenchyma surrounding the primary tumor to identify SLN.All 94 patients underwent the axillary lymph node dissection.Results For Methylene blue group and Patent blue violet group, SLN identification successful rates were 65.6% and 88.7% and accuracy rate to predict axillary lymph node status were 90.5% and 98.2% , respectively.Conclusion In identifying SLN,Patent blue violet is more ideal vital blue dye than Methylene blue, whereas the accuracy rate to predict axillary lymph node status had no significant difference.

The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance

Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m2 had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.

Advances in regional nodal management of early-stage breast cancer

With the continuous improvement of systemic treatment, reasonable local regional control of early-stage breast cancer can be translated into survival benefits. The optimization of regional nodal management in patients with limited sentinel lymph node(SLN) metastasis needs to be weighed by surgical complications, regional recurrence risk, and lymph node status, as well as other escalating treatment(systemic/radiotherapy) that may result from deescalating surgery. With the effective support and supplementation of systemic therapy and radiotherapy, the management of axillary surgery is developing in a de-escalating trend. The widespread application of neoadjuvant therapy has contributed to optimizing the management of patients with clinically node-negative/imaging nodepositive disease. In clinical practice, it is necessary to consider the residual tumor burden of regional lymph nodes when formulating the optimal irradiation fields in patients with limited positive SLN without axillary lymph node dissection. The combined application of genomic tests and American College of Surgeons Oncology Group Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In the era of sentinel lymph node biopsy(SLNB), the regional nodal management of breast cancer should adhere to the concept of “updating ideas, making bold assumptions, and carefully seeking proof”, make full use of the benefits of systemic therapy and radiotherapy to reduce the scope of surgery and complications, and expand the “net benefit” of efficacy and quality of life. This review discusses the optimization of regional nodal management in the era of SLNB, in order to provide reference information for clinicians.

Non-Axillary Sentinel Node in Breast Cancer.Are we Staging Correctly?A Multicenter Study

Purpose: The study of the sentinel lymph node is the best technique to stage, have a prognosis and decide the adequate treatment in breast cancer. The usual technique implies studding the axillary lymph node. Our work tries to identify affected nodes in other regions apart from the axilla and its possible impact in staging and treatment. Methods: The sentinel lymph node technique was performed on 1660 patients included in an observational and multicentric study designed to observe the presence of metastatic cells in axillary and non-axillary lymph nodes. Results: In 19% of the patients the sentinel lymph node was detected in non-axillary regions. In these cases metastatic cells were more frequent which could suppose a change in the stage and/or treatment. As protective factor against non-axillary nodes involvement we found the localization of the cancer in external quadrants while youth and injecting the tracer inside the tumor were found to be risk factors. Conclusions: Detecting and studding non-axillary lymph nodes in breast cancer leads to a more precise staging of the disease which could imply a change in the optimal treatment.

Using intra-operative GeneSearchTM Breast Lymph Node Assay to detect breast cancer metastases in sentinel lymph nodes： results from a single institute in China

Background Sentinel lymph node （SLN） biopsy has become a common procedure for early breast cancer patients. The GeneSearchTM Breast Lymph Node （BLN） Assay is a real-time RT-PCR assay for the detecting nodal metastases larger than 0.2 mm. China Breast Cancer Clinical Study Group （CBCSG）-001a is a prospective multi-center clinical trial that was conducted to validate the GeneSearchTM BLN Assay in China.

Retrospective analysis of sentinel lymph node biopsy using methylene blue dye for early breast cancer

Background:Methylene blue is the most commonly used tracer for sentinel lymph node(SLN)biopsy(SLNB)in China.This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye(MBD)for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.Methods:We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018.We calculated the SLN identification rate(IR)in SLNB with MBD and the false-negative rate(FNR),and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.Results:Between January 2013 and December 2018,1603 patients with early breast cancer underwent SLNB with MBD.The SLN IR was 95.8%(1536/1603).Two SLNs(median)were detected per patient.There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis(19.0%vs.4.5%,χ^(2)=12.771,P<0.001).Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status(96.3%vs.90.8%,χ^(2)=9.013,P=0.003)and tumor(T)stages(96.6%vs.94.1%,χ^(2)=5.189,P=0.023).Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection(odds ratio:0.440,95%confidence interval:0.224-0.862,P=0.017).Survival analysis showed a significant difference in disease-free survival(DFS)between patients with non-SLN metastasis and patients without non-SLN metastasis(P=0.006).Conclusion:Our single-center data show that,as a commonly used tracer in SLNB in China,MBD has an acceptable SLN IR and a low FNR in frozen sections.This finding is consistent with reports of dual tracer-guided SLNB.Positive SLNs with non-SLN metastasis are associated with DFS.

Risk factors for non-sentinel lymph node metastases in breast cancer patients with positive sentinel lymph nodes

The presence or absence of metastases in the axillary lymph nodes has remained the most powerful prognostic factor in breast carcinoma. Axillary lymph node dissection （ALND） is the standard procedure for obtaining this information. However, postoperative complications are common. Sentinel lymph node （SLN） biopsy has been proposed as a potential alternative to ALND for staging breast carcinoma. This technique has been shown to be sensitive and specific for predicting the status of the axillary lymph nodes. Furthermore, it has the potential advantage of decreasing the morbidity associated with ALND.

Diagnosis and Treatment of Axillary Web Syndrome:An Overview

Axillary web syndrome(AWS)is a self-limiting disease that can occur as an early or possibly late postoperative complication post-axillary surgery.This syndrome is characterized by the spread of the cords of subcutaneous tissue extending from the axilla into the arm and is clinically associated with pain and limited movement of the shoulder in the affected limb.Although its pathophysiology is not well established,the most common cause is surgery-related axillary lymphatic injury.Both the echography and magnetic resonance imaging results support the lymphatic hypothesis.The diagnosis of AWS is based on physical examination.Risk factors may include extensiveness of surgery,younger age,hypertension,lower body mass index,ethnicity,and healing complications.Effective clinical intervention shortens the natural course of AWS and improves the quality of life of patients with AWS.Treatments may include physical therapy,drug therapy,manual drainage,instrument-assisted soft tissue mobilization(IASTM),thoracic manipulation and stretching,manual axial distraction,percutaneous needle cord disruption with fat grafting and Xiaflex injection,and surgical intervention.Routine surgical treatment for AWS may not be recommended.Further research is needed to provide more comprehensive improvements in the diagnosis and treatment of AWS.

Application progress of lymphography in oncology

Lymphography is often used for the diagnosis of lymphatic metastasis in oncology.Determination of lymphatic metastasis is extremely important for accurate cancer staging,which may directly guide the clinical therapeutic scheme.In recent years,the technology of lymphography has developed rapidly on the basis of traditional lymphography,with the appearance of com-puted tomography(CT)lymphography,nuclear magnetic resonance(MR)lymphography,contrast-enhanced lym-phosonography,and so on;the diagnostic accuracy has also been improved.The imaging principles and methods of these various technologies of lymphography are reviewed in this paper,and their applications and significance in oncology are also discussed in detail.

Predictors of occult lymph node metastasis in cutaneous head and neck melanoma

Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.