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The Kaufman
Axillary Treatment Score (KATS)
The KATS status is an as-yet-unpublished attempt
at using some fairly objective parameters to determine the odds that a newly diagnosed case
of invasive ductal adenocarcinoma will have one or more positive axillary lymph nodes.
Axillary lymph node dissection (or sentinel lymph node biopsy [SLN]) provides one of the most
valuable bits of staging data: whether any nodes are positive for metastatic cancer (ALN+) or
negative (ALN-). But, there can be negative consequences to surgically disturbing the
axillary (arm-pit area) area. The KATS grouping was mentioned to us at a conference in Palm
Springs, California, 9/00. The originator is Cary S. Kaufman, M. D., breast surgeon at the
Bellingham Breast Center. This grouping is just an initial categorization; many other
patient-specific factors are taken together to make a final decision.
No matter what, a PALPABLE-tumor situation
is more likely to require lymph node sampling...at least a sentinel node sample
(SLN).
SIZE:
Decisions may have to be made prior to having the
whole tumor out and size-measurable. By whatever measure, the following are the criteria for
assignment of size points (such are finally, ultimately, assigned from the pathology tissue
studies):
- 0.1-0.9cm..................................................1
point
- from 1.0 cm. to 1.4
cm......................2 points
- from 1.5-1.9
cm......................................3 points
- from 2.0-3.0
cm......................................4 points
TUMOR
GRADE:
- low grade...................................................1
point
- not low
grade........................................... 2 points
Patient's AGE:
- greater than 69
years old............1 point
- 50-69 years
old...............................2 points
- less than 50 years
old...................3 points
CALCULATION FORMULA:
KATS point sum= tumor-size pts [_____] plus grade pts
[_____]
plus age pts [_____]=________total KATS sum
(points)
KATS DECISION
GROUPS
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Groups:
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<5%
risk of
ALN+
if KATS
3 or 4 sum
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20% risk
of
ALN+
if KATS
5, 6, or 7 sum
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50% risk
of
ALN+
if KATS
8 or 9 sum
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Conclusions:
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POSSIBLY
NO NODES NEEDED
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SLN MAY SUFFICE
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AXILLARY DISSECTION
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