Validation of a nomogram to predict the risk of nonsentinel lymph node metastases in breast cancer patients with a positive sentinel node biopsy: Validation of the MSKCC breast nomogram Journal Article


Authors: Van La Parra, R. F. D.; Ernst, M. F.; Bevilacqua, J. L. B.; Mol, S. J. J.; Van Zee, K. J.; Broekman, J. M.; Bosscha, K.
Article Title: Validation of a nomogram to predict the risk of nonsentinel lymph node metastases in breast cancer patients with a positive sentinel node biopsy: Validation of the MSKCC breast nomogram
Abstract: Background: Completion axillary lymph node dissection (ALND) remains the standard of care for patients with disease-positive sentinel lymph nodes (SLN). However, approximately two-thirds will have no additional disease-positive nodes. To identify the patient's individual risk for non-SLN metastases, the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram. Methods: The records of 182 breast cancer patients who underwent SLN and ALND were selected. Serial hematoxylin and eosin (HE) analysis and immunohistochemistry were routinely performed on each sentinel node. For application of the nomogram, the detection method was assigned in two ways: for all metastases visible by serial HE, the method of detection was scored as "serial HE" (method 1), independent of the tumor size, and by a combination of size and staining method (method 2); so macrometastasis were scored as detected by routine HE, micrometastasis by serial HE, and isolated tumor cells by immunohistochemistry. A receiver operating characteristic curve (ROC) was drawn, and the area under the curve was calculated to assess the discriminative power of the nomogram. Results: The area under the ROC was .71 (range, .64-.79) according to method 1 and .75 (range, .67-.88) according to method 2. Conclusions: Because the variable "method of detection" in the MSKCC nomogram is a surrogate for SLN metastasis size, the size category of the SLN metastasis can be used in applying the nomogram to patients in whom the SLN histologic analysis is performed by a much different procedure than that used to develop the MSKCC nomogram. This results in an improved predictive accuracy. © 2009 Society of Surgical Oncology.
Keywords: immunohistochemistry; adult; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; cancer risk; cancer patient; lymph node metastasis; lymph node dissection; lymph nodes; lymphatic metastasis; diagnostic accuracy; sentinel lymph node; sentinel lymph node biopsy; breast cancer; tumor volume; risk factors; validation study; breast neoplasms; medical record review; retrospective study; axillary lymph node; nomograms; staining; tumor cell; cell isolation; axilla; nomogram; roc curve
Journal Title: Annals of Surgical Oncology
Volume: 16
Issue: 5
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2009-05-01
Start Page: 1128
End Page: 1135
Language: English
DOI: 10.1245/s10434-009-0359-y
PUBMED: 19252954
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 30 November 2010" - "CODEN: ASONF" - "Source: Scopus"
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  1. Kimberly J Van Zee
    280 Van Zee