title: The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population.
abstract: OBJECTIVE
  To assess whether the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram for prediction of NSLN metastasis is useful in a German breast cancer population and whether the characteristics of the breast tumor and the sentinel lymph node (SLN) are able to predict the likelihood of non-sentinel lymph node (NSLN) metastasis.
  
  
  METHODS
  A total of 545 patients with primary breast cancer and SLN examination were evaluated. The MSKCC nomogram was applied to 98 patients with a positive SLN who subsequently had completion axillary lymph node dissection (ALND). Predictive accuracy was assessed by calculating the area under the receiver-operator characteristic (ROC) curve. The collective was evaluated by correlating the prevalence of NSLN and SLN metastasis to pathological features.
  
  
  RESULTS
  The MSKCC nomogram achieved a ROC of 0.58 indicating a bad accuracy of the nomogram. Tumor size, histology, lymphovascular infiltration, multifocality, Her-2-neu positivity, and nuclear grade correlated with the probability of SLN metastasis. Histology and primary tumor localization correlated significantly with the probability of NSLN metastasis.
  
  
  CONCLUSIONS
  The MSKCC nomogram did not provide a reliable predictive model in our study population. However, the likelihood of SLN metastasis correlated with the presumed risk factors and no obvious differences between the MSKCC population and our population could be seen. In order to achieve interinstitutional reproducibility, standardization of surgical procedure and of the pathological assessment of the SLN is desirable.
authors.affiliation: Department of Obstetrics and Gynecology, University of Freiburg, Medical School, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Klar
authors.forename: A
authors.initials: A
authors.lastname: Jochmann
authors.forename: M
authors.initials: M
authors.lastname: Foeldi
authors.forename: M
authors.initials: M
authors.lastname: Stumpf
authors.forename: G
authors.initials: G
authors.lastname: Gitsch
authors.forename: E
authors.initials: E
authors.lastname: Stickeler
authors.forename: D
authors.initials: D
authors.lastname: Watermann
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D005858:Germany; D006801:Humans; D016013:Likelihood Functions; D008207:Lymphatic Metastasis; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis; D049451:Nomograms; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity