An independent assessment of the 7 nomograms for predicting the probability of additional axillary nodal metastases after positive sentinel lymph node biopsy in a cohort of British patients with breast cancer.
INTRODUCTION
Axillary lymph node dissection (ALND) is currently the recommended procedure in patients with tumor-positive sentinel lymph node biopsy (SLNB). A significant proportion of patients with positive SLNs will not have any additional metastases in nonsentinel lymph nodes (NSLNs). Predictive nomograms could identify a subgroup of patients with low or high risk of further disease in whom completion ALND can be avoided or recommended. The aim of this study was to assess the accuracy of the currently available 7 nomograms in a cohort of British patients with breast cancer.


PATIENTS AND METHODS
A total of 138 patients with positive SLNs who underwent completion ALND were identified. Data were then used to calculate the probability of further metastases in NSLNs predicted by the 7 nomograms that are currently in use: the MSKCC (Memorial Sloan Kettering Cancer Center), Cambridge, Turkish, Stanford, MDACC (University of Texas MD Anderson Cancer Center), Tenon, and MOU (Masarykuv onkologický ústav, Masaryk Memorial Cancer Institute) models. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated for each nomogram.


RESULTS
Of the 138 patients, 54 (41%) had additional metastases in NSLNs. AUC values for the MSKCC, Cambridge, Turkish, Stanford, MDACC, Tenon, and MOU models are 0.68, 0.68, 0.70, 0.69, 0.56, 0.63, and 0.74, respectively.


CONCLUSION
The MOU nomogram was more predictive than the other nomograms, with a better AUC value and false-negative rate. None of the models were able to achieve AUC value ≥ 0.80 in a cohort of British patients with breast cancer.
['Nadeem|R M|RM|', 'Gudur|L D|LD|', 'Saidan|Z A|ZA|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001943:Breast Neoplasms D018275:Carcinoma, Lobular D005260:Female D005500:Follow-Up Studies D006801:Humans D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008875:Middle Aged D060787:Neoplasm Grading D009361:Neoplasm Invasiveness D009367:Neoplasm Staging D049451:Nomograms D011379:Prognosis D012189:Retrospective Studies D021701:Sentinel Lymph Node Biopsy D006113:United Kingdom D055815:Young Adult
Nomograms Axillary lymph nodes dissection Overall Size of Metastases in SLNs Sentinel lymph nodes biopsy non-SLNs metatstases