title: Comparison of two models for the prediction of nonsentinel node metastases in breast cancer.
abstract: BACKGROUND
  It is debated whether all patients with a positive sentinel node dissection (SLND) should be submitted to axillary lymph node dissection (ALND). Models have been developed to estimate the likelihood of nonsentinel node (non-SLN) metastases.
  
  
  METHODS
  The accuracy of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and MD Anderson scoring system for the prediction of non-SLN status was tested in a consecutive series of 186 SLN-positive breast cancer patients. A multivariate analysis was performed to assess which parameters independently predicted the presence of non-SLN metastases.
  
  
  RESULTS
  The predictive accuracy of the MSKCC nomogram measured by the receiver operating characteristic curve was 0.71, and it was best in patients with <10% risk of non-SLN metastases (sensitivity 100% and specificity 96%). The MD Anderson score predicted non-SLN involvement with low accuracy because it classified 85% of the patients in the intermediate-risk groups. Only SLN macrometastases and tumor multifocality independently predicted non-SLNs involvement.
  
  
  CONCLUSIONS
  The MSKCC nomogram can help individualize the surgical treatment of SLN-positive breast cancer when the likelihood of further axillary involvement is low or surgical risks are higher.
authors.affiliation: Academic Division of Gynecological Oncology, Institute for Cancer Research and Treatment of Candiolo, Strada Provinciale 142, 10060 Candiolo, Turin, Italy. rponzone@mauriziano.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ponzone
authors.forename: Furio
authors.initials: F
authors.lastname: Maggiorotto
authors.forename: Luca
authors.initials: L
authors.lastname: Mariani
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Jacomuzzi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Magistris
authors.forename: Paola
authors.initials: P
authors.lastname: Mininanni
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.forename: Piero
authors.initials: P
authors.lastname: Sismondi
mesh_terms: D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D012189:Retrospective Studies