Can surgical oncologists reliably predict the likelihood for non-SLN metastases in breast cancer patients? Journal Article


Authors: Smidt, M. L.; Strobbe, L. J. A.; Groenewoud, H. M. M.; Der Wilt, G. J.; Van Zee, K. J.; Wobbes, T.
Article Title: Can surgical oncologists reliably predict the likelihood for non-SLN metastases in breast cancer patients?
Abstract: Background: In approximately 40% of the breast cancer patients with sentinel lymph node (SLN) metastases, additional nodal metastases are detected in the completion axillary lymph node dissection (cALND). The MSKCC nomogram can help to quantify a patient's individual risk for non-SLN metastases with fairly accurate predicted probability. The aim of this study was to compare the predictions of surgical oncologists for non-SLN metastases with nomogram results and to clarify the impact of nomogram results on clinical decision-making. Methods: Questionnaires, containing patient scenarios, were sent to surgical oncologists involved in breast cancer care. The surgeon was asked to predict the probability for non-SLN metastases for the first five scenarios. For the remaining scenarios, the patient's actuarial likelihood, calculated by the nomogram, was supplied. The surgeon was asked whether or not (s)he would perform a cALND. The type of hospital and the surgeon's experience were registered. Results: The concordance-index amounted to 0.78, indicating moderate concurrence between the surgical predictions and nomogram results. The intersurgeon variation was important. About 25% of the surgeons was influenced by nomogram information and decided in one or more patients to abandon the cALND. Neither the type of hospital nor experience influenced predicting abilities or the clinical decision-making process. Conclusion: Individual predictions of surgical oncologists for non-SLN metastases do not correlate well with the MSKCC nomogram. The distribution between intersurgeon predictions for one scenario is important. Therefore, the nomogram is superior to clinical estimations for predicting the likelihood for non-SLN metastases. © 2006 Society of Surgical Oncology.
Keywords: cancer surgery; lymph nodes; lymphatic metastasis; lymph node excision; sentinel lymph node biopsy; metastasis; breast cancer; breast neoplasms; prediction; risk; questionnaire; correlation analysis; probability; nomograms; predictive value of tests; surgery; axilla; decision making; nomogram; normal human; calculation; lymphatic metastasis and risk assessment
Journal Title: Annals of Surgical Oncology
Volume: 14
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2007-02-01
Start Page: 615
End Page: 620
Language: English
DOI: 10.1245/s10434-006-9150-5
PUBMED: 17103070
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 10" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus"
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  1. Kimberly J Van Zee
    279 Van Zee