A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy Journal Article


Authors: Van Zee, K. J.; Manasseh, D. M. E.; Bevilacqua, J. L. B.; Boolbol, S. K.; Fey, J. V.; Tan, L. K.; Borgen, P. I.; Cody, H. S. 3rd; Kattan, M. W.
Article Title: A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy
Abstract: Background: The standard of care for breast cancer patients with sentinel lymph node (SLN) metastases includes complete axillary lymph node dissection (ALND). However, many question the need for complete ALND in every patient with detectable SLN metastases, particularly those perceived to have a low risk of non-SLN metastases. Accurate estimates of the likelihood of additional disease in the axilla could assist greatly in decision-making regarding further treatment. Methods: Pathological features of the primary tumor and SLN metastases of 702 patients who underwent complete ALND were assessed with multivariable logistic regression to predict the presence of additional disease in the non-SLNs of these patients. A nomogram was created using pathological size, tumor type and nuclear grade, lymphovascular invasion, multifocality, and estrogen-receptor status of the primary tumor; method of detection of SLN metastases; number of positive SLNs; and number of negative SLNs. The model was subsequently applied prospectively to 373 patients. Results: The nomogram for the retrospective population was accurate and discriminating, with an area under the receiver operating characteristic (ROC) curve of 0.76. When applied to the prospective group, the model accurately predicted likelihood of non-SLN disease (ROC, 0.77). Conclusions: We have developed a user-friendly nomogram that uses information commonly available to the surgeon to easily and accurately calculate the likelihood of having additional, non-SLN metastases for an individual patient. © 2003 The Society of Surgical Oncology, Inc.
Keywords: adult; controlled study; aged; middle aged; major clinical study; cancer risk; patient selection; lymph node metastasis; sentinel node; cancer diagnosis; lymph nodes; lymphatic metastasis; cancer grading; diagnostic accuracy; prospective study; lymph node excision; prospective studies; sentinel lymph node biopsy; lymphadenectomy; breast cancer; tumor volume; logistic models; pathology; breast neoplasms; retrospective study; prediction; risk assessment; carcinogenesis; cancer invasion; lymph vessel; axillary lymph node; correlation analysis; population research; discriminant analysis; breast tumor; lymph node; reference values; prediction and forecasting; predictive value of tests; multivariate logistic regression analysis; axilla; estrogen receptor; decision making; statistical model; nomogram; technique; roc curve; reference value; axillary metastases; humans; human; female; article
Journal Title: Annals of Surgical Oncology
Volume: 10
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2003-12-01
Start Page: 1140
End Page: 1151
Language: English
DOI: 10.1245/aso.2003.03.015
PUBMED: 14654469
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 12 September 2014 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Lee K Tan
    144 Tan
  2. Kimberly J Van Zee
    279 Van Zee
  3. Hiram S Cody III
    235 Cody
  4. Patrick I Borgen
    253 Borgen
  5. Jane Fey
    66 Fey
  6. Michael W Kattan
    218 Kattan