title: A Dutch Prediction Tool to Assess the Risk of Additional Axillary Non-Sentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer Patients.
abstract: BACKGROUND
  Multiple predictive systems have previously been developed to identify the sentinel lymph node (SLN)-positive patients at low risk of additional axillary non-SLN involvement and for whom completion axillary lymph node dissection (ALND) could be avoided. However, previous studies showed that these tools had poor performance in Dutch patients with breast cancer, probably owing to variations in pathology settings and differences in population characteristics. The aim of the present study was to develop a predictive tool for the risk of non-SLN involvement in a Dutch population with SLN-positive breast cancer.
  
  
  METHODS
  The data from 513 patients with SLN-positive breast cancer at 10 participating hospitals, who had undergone ALND from January 2007 to December 2008 were studied. The uni- and multivariable associations of predictors for non-SLN metastases were analyzed, and a predictive model was developed. The discriminatory ability of the model was measured by the area under the receiver operating characteristic curve (AUC) and the agreement between predicted probabilities and observed frequencies was visualized by a calibration plot.
  
  
  RESULTS
  A predictive model was developed that included the 2 strongest predictors: the size of the SLN metastases in millimeters and the presence of a negative sentinel lymph node. The model showed good discriminative ability (AUC, 0.75) and good calibration over the complete range of predicted probabilities.
  
  
  CONCLUSIONS
  We have developed a tool to predict additional non-SLN metastases in Dutch patients with SLN-positive breast cancer that is easy to use in daily clinical breast cancer practice.
authors.affiliation: Departement of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. Electronic address: vandenhoven.ingrid@gmail.com.
authors.forename: Ingrid
authors.initials: I
authors.lastname: van den Hoven
authors.affiliation: Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: van Klaveren
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; Department of Medical Oncology, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Epidemiology, School of Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Adri C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.affiliation: Department of Medical Oncology, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Vivianne
authors.initials: V
authors.lastname: Tjan-Heijnen
authors.affiliation: Departement of Surgery, Máxima Medical Center, Veldhoven, The Netherlands; Department of Medical Oncology, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Rudi M H
authors.initials: RM
authors.lastname: Roumen
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; 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; D007124:Immunoenzyme Techniques; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D015233:Models, Statistical; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009426:Netherlands; D049451:Nomograms; D011379:Prognosis; D012372:ROC Curve; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012307:Risk Factors; D000071036:Sentinel Lymph Node / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Axillary lymph node involvement; Non-SLN metastases; Predictive system; SLN-positive breast cancer