D-dimer as a Predictive Factor of Axillary Lymph Node Metastases in Operable Breast Cancer Patients in the Teaching Hospital of Universitas Sumatera Utara

BACKGROUND: Axillary lymph node (ALN) involvement in breast cancer (BC) is considered to be a significant factor in determining the diseases’ extent at the moment. The spreading capacity of cancerous cells may linearly correlate with its activity level, which in turn alter the coagulation function as commonly represented by fibrin degradation biomarker i.e., D-dimer. Although ALN metastatic status is eventually should be perceptible in physical examinations or other diagnostic modalities, an additional marker to estimate the lymph node extent should be considered in the pre-operative sessions. OBJECTIVE: To provide the correlation between elevated D-dimer level and ALN metastatic status positivity among BC patients. METHODS: This cross-sectional study was conducted at the Teaching Hospital of Universitas Sumatera Utara by retrieving outpatients’ medical records from June 2018 to January 2019, encompassing 111 female patients. The ALN involvement status was recorded along with plasma D-dimer level in which the value of 500 ng/mL was considered to be elevated. RESULTS: From the 102 eligible participants, 47.1% and 70.6% were confirmed with elevated D-dimer level and ALN involved respectively. Further analysis of those variables demonstrated a considerable diagnostic performance for sensitivity (64.4%), specificity (79.1%), PPV (80.9%), NPV (61.8%), accuracy (70.6%) and statistically significant results (P = .001). CONCLUSION: Elevated D-dimer level may be influenced by cancerous spread capacity in the lymphatic system, as it also eventually correlated with coagulation system dysregulation. Therefore, it is suggested that the role of D-dimer measurement is recommended to be explored further in BC diagnostic workup.