title: A breast cancer nomogram for prediction of non-sentinel node metastasis - validation of fourteen existing models.
abstract: BACKGROUND
  To avoid performing axillary lymph node dissection (ALND) for non-sentinel lymph node (SLN)-negative patients with-SLN positive axilla, nomograms for predicting the status have been developed in many centers. We created a new nomogram predicting non-SLN metastasis in SLN-positive patients with invasive breast cancer and evaluated 14 existing breast cancer models in our patient group.
  
  
  METHODS
  Two hundred and thirty seven invasive breast cancer patients with SLN metastases who underwent ALND were included in the study. Based on independent predictive factors for non-SLN metastasis identified by logistic regression analysis, we developed a new nomogram. Receiver operating characteristics (ROC) curves for the models were created and the areas under the curves (AUC) were computed.
  
  
  RESULTS
  In a multivariate analysis, tumor size, presence of lymphovascular invasion, extranodal extension of SLN, large size of metastatic SLN, the number of negative SLNs, and multifocality were found to be independent predictive factors for non-SLN metastasis. The AUC was found to be 0.87, and calibration was good for the present Ondokuz Mayis nomogram. Among the 14 validated models, the MSKCC, Stanford, Turkish, MD Anderson, MOU (Masaryk), Ljubljana, and DEU models yielded excellent AUC values of > 0.80.
  
  
  CONCLUSIONS
  We present a new model to predict the likelihood of non-SLN metastasis. Each clinic should determine and use the most suitable nomogram or should create their own nomograms for the prediction of non- SLN metastasis.
authors.affiliation: General Surgery, Korgan Devlet Hastanesi, Ordu, Turkey E-mail : bekirkuru@gmail.com, bekirkuru@yahoo.com.
authors.forename: Bulent
authors.initials: B
authors.lastname: Koca
authors.forename: Bekir
authors.initials: B
authors.lastname: Kuru
authors.forename: Necati
authors.initials: N
authors.lastname: Ozen
authors.forename: Savas
authors.initials: S
authors.lastname: Yoruker
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Bek
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D049451:Nomograms; D012372:ROC Curve; D021701:Sentinel Lymph Node Biopsy