title: Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a new predictive nomogram.
abstract: BACKGROUND
  The accurate prediction of nonsentinel node (NSN) metastasis in breast cancer patients remains uncertain.
  
  
  METHODS
  The medical records of 574 breast cancer patients from 2 different institutions (Mayo Clinic and University of Michigan) with sentinel lymph node biopsy examination and completion axillary lymph node dissection were reviewed for multiple clinicopathologic variables. The Memorial Sloan Kettering Cancer Center nomogram performance for prediction of NSN metastases was assessed. A new model was developed with clinically relevant variables and possible advantages.
  
  
  RESULTS
  The Memorial Sloan Kettering Cancer Center nomogram predicted the likelihood of NSN metastasis with an area under the receiver operating characteristic curve of .72 and .86. For predicted probability cut-off points of 5% and 10%, the false-negative rates were 0% and 14% (Mayo), and 17% and 11% (Michigan). A new model was developed with similar area under the curve but lower false-negative rates for low-probability subgroups.
  
  
  CONCLUSIONS
  Predictive models for NSN tumor burden are imperfect.
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First St., SW, Rochester, MN 55905, USA. Degnim.Amy@mayo.edu
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.forename: Carol
authors.initials: C
authors.lastname: Reynolds
authors.forename: Gouri
authors.initials: G
authors.lastname: Pantvaidya
authors.forename: Shaheen
authors.initials: S
authors.lastname: Zakaria
authors.forename: Tanya
authors.initials: T
authors.lastname: Hoskin
authors.forename: Sunni
authors.initials: S
authors.lastname: Barnes
authors.forename: Margaret V
authors.initials: MV
authors.lastname: Roberts
authors.forename: Peter C
authors.initials: PC
authors.lastname: Lucas
authors.forename: Kevin
authors.initials: K
authors.lastname: Oh
authors.forename: Meryem
authors.initials: M
authors.lastname: Koker
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D008954:Models, Biological; D049451:Nomograms; D011237:Predictive Value of Tests