Can Axillary Positivity Be Predicted Using Hemogram Parameters in Patients with Breast Cancer at the Time of Diagnosis?

Abstract

Background: Axillary lymph node status is a key prognostic factor in breast cancer and guides treatment decisions. Sentinel lymph node biopsy (SLNB) is the standard staging method in clinically node-negative patients; however, it remains invasive. Inflammatory indices derived from complete blood counts, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), have been investigated as potential markers of nodal involvement.

Aim: This study aimed to evaluate the predictive performance of NLR, PLR, and LMR for axillary lymph node positivity and SLNB outcomes in breast cancer.

Methods: This single-center retrospective study included 203 female patients with histopathologically confirmed invasive breast cancer. All patients underwent preoperative axillary ultrasonography, and suspicious lymph nodes were evaluated using fine-needle aspiration biopsy. SLNB was performed in 91 patients with imaging-negative axillae. Preoperative hemogram parameters were recorded, and NLR, PLR, and LMR were calculated. These indices were compared between axillary lymph node (ALN)-positive and ALN-negative patients, and between SLNB-positive and SLNB-negative subgroups.

Results: NLR and LMR values were significantly higher, whereas PLR values were significantly lower ( P < 0.001), lymphocyte counts were also higher ( P < 0.05) in patients with ALN positivity group, while neutrophil and platelet counts showed no significant differences. Among patients undergoing SLNB, no significant differences in inflammatory indices were observed, and these parameters failed to distinguish micro- from macrometastatic disease.

Conclusion: Hemogram-derived inflammatory indices are associated with axillary nodal positivity but are insufficient to predict low-volume nodal disease detected by SLNB and should be considered complementary tools in axillary staging.