title: Value of Memorial Sloan-Kettering Cancer Center nomogram in clinical decision making for sentinel lymph node-positive breast cancer.
abstract: BACKGROUND
  The aim of this study was to determine the value of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram for individual decision making in a Dutch cohort of women with breast cancer with a positive sentinel lymph node (SLN) but at low risk of additional nodal metastases.
  
  
  METHODS
  Data were collected on 168 patients with a positive SLN who underwent completion axillary lymph node dissection. The predicted probability of non-SLN metastases was calculated for each patient, using the MSKCC nomogram. Specificity and false-negative rates were calculated for subgroups with a predicted risk of no more than 5, 10 or 15 per cent. A receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) calculated.
  
  
  RESULTS
  The discrimination of the MSKCC nomogram, measured by the AUC, was 0.68. For low predicted probability cut-off values of no more than 5, 10 and 15 per cent, the false-negative rates were 20, 14 and 19 per cent, and the specificities were 4, 27 and 32 per cent, respectively. The low-risk category (5 per cent or less) consisted of only 3.0 per cent of the study population.
  
  
  CONCLUSIONS
  The performance of the MSKCC nomogram was insufficient to make it a useful tool for individual decision making in this cohort of women with SLN-positive breast cancer.
authors.affiliation: Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands. i.vandenhoven@mmc.nl
authors.forename: I
authors.initials: I
authors.lastname: van den Hoven
authors.forename: G P
authors.initials: GP
authors.lastname: Kuijt
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.forename: M W P M
authors.initials: MW
authors.lastname: van Beek
authors.forename: R M H
authors.initials: RM
authors.lastname: Roumen
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002173:Cancer Care Facilities; D003657:Decision Making; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049451:Nomograms; D021701:Sentinel Lymph Node Biopsy; D047368:Tumor Burden