title: A new and simple predictive formula for non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph nodes, and validation of 3 different nomograms in Turkish breast cancer patients.
abstract: BACKGROUND
  Nomogram accuracies for predicting non-sentinel lymph node (SLN) involvement vary between different patient populations. Our aim is to put these nomograms to test on our patient population and determine our individual predictive parameters affecting SLN and non-SLN involvement.
  
  
  METHODS
  Data from 932 patients was analyzed. Nomogram values were calculated for each patient utilizing MSKCC, Tenon, and MHDF models. Moreover, using our own patient- and tumor-depended parameters, we established a unique predictivity formula for SLN and non-SLN involvement.
  
  
  RESULTS
  The calculated area under the curve (AUC) values for MSKCC, Tenon, and MHDF models were 0.727 (95% confidence interval (CI) 0.64-0.8), 0.665 (95% CI 0.59-0.73), and 0.696 (95% CI 0.59-0.79), respectively. Cerb-2 positivity (p = 0.004) and size of the metastasis in the lymph node (p = 0.006) were found to correlate with non-SLN involvement in our study group. The AUC value of the predictivity formula established using these parameters was 0.722 (95% CI 0.63-0.81).
  
  
  CONCLUSIONS
  The most accurate nomogram for our patient group was the MSKCC nomogram. Our unique predictivity formula proved to be as equally effective and competent as the MSKCC nomogram. However, similar to other nomograms, our predictivity formula requires future validation studies.
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Yeniay
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Carti
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Karaca
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Zekioglu
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Ulkem
authors.initials: U
authors.lastname: Yararbas
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Rasih
authors.initials: R
authors.lastname: Yilmaz
authors.affiliation: Ege University School of Medicine, Izmir, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Kapkac
keywords: MSKCC nomogram; Non-sentinel lymph node metastasis; Sentinel lymph node biopsy; Tenon score; Turkish nomogram