title: A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound.
abstract: Among patients with a preoperative positive axillary ultrasound, around 40% of them are pathologically proved to be free from axillary lymph node (ALN) metastasis. We aimed to develop and validate a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. Clinicopathological features of 322 early breast cancer patients with positive axillary ultrasound findings were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of ALN metastasis. A model was created from the logistic regression analysis, comprising lymph node transverse diameter, cortex thickness, hilum status, clinical tumour size, histological grade and estrogen receptor, and it was subsequently validated in another 234 patients. Coefficient of determination (R(2)) and the area under the ROC curve (AUC) were calculated to be 0.9375 and 0.864, showing good calibration and discrimination of the model, respectively. The false-negative rates of the model were 0% and 5.3% for the predicted probability cut-off points of 7.1% and 13.8%, respectively. This means that omission of axillary surgery may be safe for patients with a predictive probability of less than 13.8%. After further validation in clinical practice, this model may support increasingly limited surgical approaches to the axilla in breast cancer.
authors.affiliation: The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China.|Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Si-Qi
authors.initials: SQ
authors.lastname: Qiu
authors.affiliation: The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China.
authors.forename: Huan-Cheng
authors.initials: HC
authors.lastname: Zeng
authors.affiliation: Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Guangdong, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound Diagnosis, Cancer Hospital of Shantou University Medical College, Guangdong, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Chen
authors.affiliation: The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China.
authors.forename: Wen-He
authors.initials: WH
authors.lastname: Huang
authors.affiliation: Department of Internal Medicine, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Rick G
authors.initials: RG
authors.lastname: Pleijhuis
authors.affiliation: The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China.
authors.forename: Jun-Dong
authors.initials: JD
authors.lastname: Wu
authors.affiliation: Department of Surgery, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Gooitzen M
authors.initials: GM
authors.lastname: van Dam
authors.affiliation: The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China.|Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Guangdong, China.|Cancer Research Center, Shantou University Medical College, Guangdong, China.
authors.forename: Guo-Jun
authors.initials: GJ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D014463:Ultrasonography