Are the MIA and MSKCC nomograms useful in selecting patients with melanoma for sentinel lymph node biopsy? Journal Article
| Authors: | Hosein, S.; Drebin, H. M.; Kurtansky, N. R.; Olofsson Bagge, R.; Coit, D. G.; Bartlett, E. K.; Marchetti, M. A. |
| Article Title: | Are the MIA and MSKCC nomograms useful in selecting patients with melanoma for sentinel lymph node biopsy? |
| Abstract: | Background and Methods: The Melanoma Institute of Australia (MIA) and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms were developed to help guide sentinel lymph node biopsy (SLNB) decisions. Although statistically validated, whether these prediction models provide clinical benefit at National Comprehensive Cancer Network guideline-endorsed thresholds is unknown. We conducted a net benefit analysis to quantify the clinical utility of these nomograms at risk thresholds of 5%–10% compared to the alternative strategy of biopsying all patients. External validation data for MIA and MSKCC nomograms were extracted from respective published studies. Results: The MIA nomogram provided added net benefit at a risk threshold of 9% but net harm at 5%–8% and 10%. The MSKCC nomogram provided added net benefit at risk thresholds of 5% and 9%–10% but net harm at 6%–8%. When present, the magnitude of net benefit was small (1–3 net avoidable biopsies per 100 patients). Conclusion: Neither model consistently provided added net benefit compared to performing SLNB for all patients. Discussion: Based on published data, use of the MIA or MSKCC nomograms as decision-making tools for SLNB at risk thresholds of 5%–10% does not clearly provide clinical benefit to patients. © 2023 Wiley Periodicals LLC. |
| Keywords: | adult; middle aged; major clinical study; patient selection; cancer patient; lymph node metastasis; lymph nodes; lymphatic metastasis; sensitivity and specificity; sentinel lymph node biopsy; melanoma; pathology; validation study; breast neoplasms; false negative result; cancer center; nomograms; breast tumor; lymph node; australia; false positive result; clinical utility; nomogram; predictive value; roc curve; receiver operating characteristic; breslow thickness; sentinel lymph node metastasis; predictive model; humans; human; female; article; positivity rate |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 127 |
| Issue: | 7 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2023-06-01 |
| Start Page: | 1167 |
| End Page: | 1173 |
| Language: | English |
| DOI: | 10.1002/jso.27231 |
| PUBMED: | 36905337 |
| PROVIDER: | scopus |
| PMCID: | PMC10147582 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF and PubMed -- MSK corresponding author is Michael Marchetti -- Export Date: 31 May 2023 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work