title: An independent assessment of the 7 nomograms for predicting the probability of additional axillary nodal metastases after positive sentinel lymph node biopsy in a cohort of British patients with breast cancer.
abstract: BACKGROUND
  Axillary lymph node dissection (ALND) is currently the recommended procedure in patients with tumor-positive sentinel lymph node biopsy (SLNB). A significant proportion of patients with positive SLNs will not have any additional metastases in nonsentinel lymph nodes (NSLNs). Predictive nomograms could identify a subgroup of patients with low or high risk of further disease in whom completion ALND can be avoided or recommended. The aim of this study was to assess the accuracy of the currently available 7 nomograms in a cohort of British patients with breast cancer.
  
  
  METHODS
  A total of 138 patients with positive SLNs who underwent completion ALND were identified. Data were then used to calculate the probability of further metastases in NSLNs predicted by the 7 nomograms that are currently in use: the MSKCC (Memorial Sloan Kettering Cancer Center), Cambridge, Turkish, Stanford, MDACC (University of Texas MD Anderson Cancer Center), Tenon, and MOU (Masarykuv onkologický ústav, Masaryk Memorial Cancer Institute) models. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated for each nomogram.
  
  
  RESULTS
  Of the 138 patients, 54 (41%) had additional metastases in NSLNs. AUC values for the MSKCC, Cambridge, Turkish, Stanford, MDACC, Tenon, and MOU models are 0.68, 0.68, 0.70, 0.69, 0.56, 0.63, and 0.74, respectively.
  
  
  CONCLUSIONS
  The MOU nomogram was more predictive than the other nomograms, with a better AUC value and false-negative rate. None of the models were able to achieve AUC value ≥ 0.80 in a cohort of British patients with breast cancer.
authors.affiliation: Department of Breast Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom. Electronic address: Nadeem_rana@hotmail.com.
authors.forename: R M
authors.initials: RM
authors.lastname: Nadeem
authors.affiliation: Department of Cellular Pathology, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: L D
authors.initials: LD
authors.lastname: Gudur
authors.affiliation: Department of Breast Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Saidan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D006113:United Kingdom; D055815:Young Adult
keywords: Axillary lymph nodes dissection; Nomograms; Overall Size of Metastases in SLNs; Sentinel lymph nodes biopsy; non-SLNs metatstases