title: Validation of Six Nomograms for Predicting Non-sentinel Lymph Node Metastases in a Dutch Breast Cancer Population.
abstract: BACKGROUND
  The usefulness of axillary lymph node dissection (ALND) in patients with positive sentinel nodes (SN) is still an ongoing debate. Several nomograms have been developed for predicting non-sentinel lymph node metastases (NSLNM). We validated six nomograms using data from 10 years of breast cancer surgery in our hospital.
  
  
  METHODS
  We retrospectively analyzed all patients with a proven breast malignancy and a SN procedure between 2001 and 2011 in our hospital.
  
  
  RESULTS
  Data from 1084 patients were reviewed; 260 (24 %) had a positive SN. No patients with isolated tumor cells, 6 patients (8 %) with micrometastases, and 65 patients (41 %) with macrometastases had additional axillary NSLNM. In 2 patients (3 %) with micrometastases, the ALND influenced postoperative treatment. In the group of patients with macrometastases tumor size >2 cm, extranodal growth and having no negative SNs were predictors of NSLNM. The revised MD Anderson Cancer Center and Helsinki nomograms performed the best, with an area under the curve value of 0.78.
  
  
  CONCLUSIONS
  ALND could probably be safely omitted in most patients with micrometastases but is still indicated in patients with macrometastases, especially in patients with tumor size >2 cm, extranodal growth, and no negative SNs. The revised MD Anderson Cancer Center and Helsinki nomograms were the most predictive in our patient group.
authors.affiliation: Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands. s.a.dingemans@amc.nl.
authors.forename: Siem A
authors.initials: SA
authors.lastname: Dingemans
authors.affiliation: Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: de Rooij
authors.affiliation: Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Roos M
authors.initials: RM
authors.lastname: van der Vuurst de Vries
authors.affiliation: Department of Pathology, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Leo M
authors.initials: LM
authors.lastname: Budel
authors.affiliation: Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Contant
authors.affiliation: Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Anne E M
authors.initials: AE
authors.lastname: van der Pool
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015233:Models, Statistical; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone