A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy.
BACKGROUND
The standard of care for breast cancer patients with sentinel lymph node (SLN) metastases includes complete axillary lymph node dissection (ALND). However, many question the need for complete ALND in every patient with detectable SLN metastases, particularly those perceived to have a low risk of non-SLN metastases. Accurate estimates of the likelihood of additional disease in the axilla could assist greatly in decision-making regarding further treatment.


METHODS
Pathological features of the primary tumor and SLN metastases of 702 patients who underwent complete ALND were assessed with multivariable logistic regression to predict the presence of additional disease in the non-SLNs of these patients. A nomogram was created using pathological size, tumor type and nuclear grade, lymphovascular invasion, multifocality, and estrogen-receptor status of the primary tumor; method of detection of SLN metastases; number of positive SLNs; and number of negative SLNs. The model was subsequently applied prospectively to 373 patients.


RESULTS
The nomogram for the retrospective population was accurate and discriminating, with an area under the receiver operating characteristic (ROC) curve of 0.76. When applied to the prospective group, the model accurately predicted likelihood of non-SLN disease (ROC, 0.77).


CONCLUSIONS
We have developed a user-friendly nomogram that uses information commonly available to the surgeon to easily and accurately calculate the likelihood of having additional, non-SLN metastases for an individual patient.
Van Zee
Kimberly J
KJ
Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. vanzeek@mskcc.org
Manasseh
Donna-Marie E
DM
Bevilacqua
Jose L B
JL
Boolbol
Susan K
SK
Fey
Jane V
JV
Tan
Lee K
LK
Borgen
Patrick I
PI
Cody
Hiram S
HS
Kattan
Michael W
MW
D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy