Meme Kanserinde Aksiller Lenf Nodu Metastazını Öngörmede CALLY İndeksinin Sınırlı Tanısal Değeri: Retrospektif Tanısal Doğruluk Analizi

Öz

Amaç: Bu çalışmanın amacı, preoperatif dönemde C-Reaktif Protein–Albümin–Lenfosit (CALLY) indeksinin meme kanserinde aksiller lenf nodu (ALN) metastazını ayırt etmedeki tanısal performansını değerlendirmektir.

Materyal ve metod: Haziran 2023-Ocak 2025 arasında meme kanseri nedeniyle cerrahi uygulanan 59 ardışık kadın hasta retrospektif olarak incelendi. CALLY şu şekilde hesaplandı: (Albümin [g/dL] × Lenfosit [10⁹/L])/(CRP [mg/dL] × 10⁴). ROC analizi ile kesme değeri (≤1,9) belirlendi; hastalar düşük CALLY (Grup 1) ve yüksek CALLY (Grup 2) olarak sınıflandırıldı. CALLY’nin ALN pozitifliğini öngörmedeki duyarlılık/özgüllüğü hesaplandı ve klinikopatolojik değişkenler gruplar arasında karşılaştırıldı. Haziran 2023-Ocak 2025 arasında meme kanseri nedeniyle cerrahi uygulanan 59 ardışık kadın hasta retrospektif olarak incelendi. CALLY şu şekilde hesaplandı: (Albümin [g/dL] × Lenfosit [10⁹/L])/(CRP [mg/dL] × 10⁴). ROC analizi ile kesme değeri (≤1,9) belirlendi; hastalar düşük CALLY (Grup 1) ve yüksek CALLY (Grup 2) olarak sınıflandırıldı. CALLY’nin ALN pozitifliğini öngörmedeki duyarlılık/özgüllüğü hesaplandı ve klinikopatolojik değişkenler gruplar arasında karşılaştırıldı.

Bulgular: Grup 1’de 28, Grup 2’de 31 hasta vardı. ROC analizi AUC=0,503; p=0,968 gösterdi. Kesme ≤1,9 için duyarlılık %43, özgüllük %53 olup klinik olarak anlamlı ayırt edicilik sağlamadı. Düşük CALLY grubunda albümin daha düşük, CRP daha yüksek ve lenfosit sayısı daha düşük saptandı (sırasıyla p<0,001; p=0,001; p=0,002). Sentinel lenf nodu biyopsisi oranları gruplar arasında benzerdi. CALLY ile metastatik ve toplam lenf nodu sayıları arasında anlamlı korelasyon izlenmedi.

Sonuç: Bileşenleri tek tek istatistiksel farklılık gösterse de CALLY indeksi, bu kohortta ALN metastazını öngörmek için klinik olarak kullanışlı bir skorlama sistemi değildir. Bulgular, aksiller evrelemede tek başına inflamasyon temelli indekslere güvenilmemesi gerektiğine işaret eden negatif tanısal kanıt sunmaktadır.

Anahtar Kelimeler

• Meme kanseri
• CALLY indeksi
• Aksiller lenf nodu metastazı

Limited Diagnostic Value of the CALLY Index for Predicting Axillary Lymph Node Metastasis in Breast Cancer: A Retrospective Diagnostic-Accuracy Study

Öz

Background: To evaluate the diagnostic performance of the C-reactive protein–albumin–lymphocyte (CALLY) index in discriminating axillary lymph node (ALN) metastasis in breast cancer during the preoperative period.

Materials and Methods: We retrospectively analyzed 59 consecutive female patients who underwent surgery for breast cancer between June 2023 and January 2025. The CALLY index was calculated as (Albumin [g/dL] × Lymphocyte count [10⁹/L])/(CRP [mg/dL] × 10⁴). A receiver operating characteristic (ROC) analysis determined the cut-off (≤1.9); patients were stratified into low CALLY (Group 1) and high CALLY (Group 2). Sensitivity/specificity for ALN positivity were computed, and clinicopathological variables were compared between groups. Results: Twenty-eight patients were allocated to Group 1 and thirty-one to Group 2. ROC analysis yielded AUC=0.503; p=0.968. At the ≤1.9 cut-off, sensitivity was 43% and specificity 53%, indicating no clinically meaningful discrimination. Compared with the high-CALLY group, the low-CALLY group showed lower albumin, higher CRP, and lower lymphocyte counts (respectively p<0.001; p=0.001; p=0.002). Sentinel lymph node biopsy rates were similar between groups. There was no significant correlation between the CALLY index and either the number of metastatic or total excised lymph nodes.

Conclusions: Although its individual components differ statistically, the CALLY index alone is not a clinically useful scoring system for predicting ALN metastasis in this cohort. These negative diagnostic findings caution against relying solely on inflammation-based composite indices for axillary staging. Keywords: Breast cancer, CALLY index, Axillary lymph nodeAnahtar Kelimeler: Meme kanseri, CALLY indeksi, Aksiller lenf nodu metastazı

Anahtar Kelimeler

• reast cancer
• CALLY index
• Axillary lymph node

Kaynakça

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