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

作者：Nadeem R M^*; Gudur L D; Saidan Z A

来源：Clinical Breast Cancer, 2014, 14(4): 272-279.

DOI：10.1016/j.clbc.2014.02.006

• Axillary lymph nodes dissection
• Nomograms
• non-SLNs metatstases
• Overall Size of Metastases in SLNs
• Sentinel lymph nodes biopsy

Axillary lymph node dissection is associated with morbidity and its routine use in all patients with metastatic SLNs is debatable. Seven Nomograms to predict the probability of further additional non-SLNs metastases were independently validated with variable results in British population.
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 onkologicky ustav, 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.

• 出版日期2014-8