Validation of Memorial Sloan-Kettering Cancer Center nomogram for prediction of non-sentinel lymph node metastasis in sentinel lymph node positive breast cancer patients an international comparison

Yao Lung Kuo, Wen Chung Chen, Wei Jen Yao, Lili Cheng, Hui Ping Hsu, Hung Wen Lai, Shou Jen Kuo, Dar Ren Chen, Tsai Wang Chang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Current guidelines for breast cancer treatment recommend completion axillary lymph node dissection (CALND) following in case of positive sentinel lymph node (SLN) metastasis, which only in 35%-70% shows additional nodal metastases. Several nomograms and scoring systems have been created to predict the risk of metastasis in non-SLNs. The aim of the study was to identify individual patient risk for non-sentinel lymph node metastasis by validating with MSKCC nomogram and to evaluate the variability within a group of SLN-positive breast cancer patients with the final goal of avoiding unnecessary CALND. Patients and methods: We retrospectively evaluated 1496 primary breast cancer patients. 324 women with a positive SLN who underwent CALND were identified. The predictive accuracy was measured and compared with the MSKCC nomogram by the area under the receiver operating characteristic curve. Receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity, and the area under the curve (AUC) was calculated. Results: At least one metastatic non-SLN were identified in 88/324 (27.2%) patients. Tumor size, tumor type, tumor grade, number of positive SLNs and number of negative SLNs were significantly associated with non-SLN status in multivariate analyses. The MSKCC nomogram showed an AUC value of 0.738 (95% confidence interval=0.682-0.793) after the validation for our collectives. Conclusions: The MSKCC nomogram showed a good prediction for the non-SLN metastasis and performed adequately in our patient collective. Therefore, for the use of nomogram, validation with other populations of patients is strongly suggested.

Original languageEnglish
Pages (from-to)538-543
Number of pages6
JournalInternational Journal of Surgery
Volume11
Issue number7
DOIs
Publication statusPublished - 2013 Jun 11

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Nomograms
Lymph Nodes
Breast Neoplasms
Neoplasm Metastasis
Lymph Node Excision
Neoplasms
ROC Curve
Area Under Curve
Sentinel Lymph Node
Multivariate Analysis
Guidelines
Confidence Intervals
Sensitivity and Specificity
Population

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{70dbb5aa94a641dcaf29aac0eea977d2,
title = "Validation of Memorial Sloan-Kettering Cancer Center nomogram for prediction of non-sentinel lymph node metastasis in sentinel lymph node positive breast cancer patients an international comparison",
abstract = "Background: Current guidelines for breast cancer treatment recommend completion axillary lymph node dissection (CALND) following in case of positive sentinel lymph node (SLN) metastasis, which only in 35{\%}-70{\%} shows additional nodal metastases. Several nomograms and scoring systems have been created to predict the risk of metastasis in non-SLNs. The aim of the study was to identify individual patient risk for non-sentinel lymph node metastasis by validating with MSKCC nomogram and to evaluate the variability within a group of SLN-positive breast cancer patients with the final goal of avoiding unnecessary CALND. Patients and methods: We retrospectively evaluated 1496 primary breast cancer patients. 324 women with a positive SLN who underwent CALND were identified. The predictive accuracy was measured and compared with the MSKCC nomogram by the area under the receiver operating characteristic curve. Receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity, and the area under the curve (AUC) was calculated. Results: At least one metastatic non-SLN were identified in 88/324 (27.2{\%}) patients. Tumor size, tumor type, tumor grade, number of positive SLNs and number of negative SLNs were significantly associated with non-SLN status in multivariate analyses. The MSKCC nomogram showed an AUC value of 0.738 (95{\%} confidence interval=0.682-0.793) after the validation for our collectives. Conclusions: The MSKCC nomogram showed a good prediction for the non-SLN metastasis and performed adequately in our patient collective. Therefore, for the use of nomogram, validation with other populations of patients is strongly suggested.",
author = "Kuo, {Yao Lung} and Chen, {Wen Chung} and Yao, {Wei Jen} and Lili Cheng and Hsu, {Hui Ping} and Lai, {Hung Wen} and Kuo, {Shou Jen} and Chen, {Dar Ren} and Chang, {Tsai Wang}",
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Validation of Memorial Sloan-Kettering Cancer Center nomogram for prediction of non-sentinel lymph node metastasis in sentinel lymph node positive breast cancer patients an international comparison. / Kuo, Yao Lung; Chen, Wen Chung; Yao, Wei Jen; Cheng, Lili; Hsu, Hui Ping; Lai, Hung Wen; Kuo, Shou Jen; Chen, Dar Ren; Chang, Tsai Wang.

In: International Journal of Surgery, Vol. 11, No. 7, 11.06.2013, p. 538-543.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Validation of Memorial Sloan-Kettering Cancer Center nomogram for prediction of non-sentinel lymph node metastasis in sentinel lymph node positive breast cancer patients an international comparison

AU - Kuo, Yao Lung

AU - Chen, Wen Chung

AU - Yao, Wei Jen

AU - Cheng, Lili

AU - Hsu, Hui Ping

AU - Lai, Hung Wen

AU - Kuo, Shou Jen

AU - Chen, Dar Ren

AU - Chang, Tsai Wang

PY - 2013/6/11

Y1 - 2013/6/11

N2 - Background: Current guidelines for breast cancer treatment recommend completion axillary lymph node dissection (CALND) following in case of positive sentinel lymph node (SLN) metastasis, which only in 35%-70% shows additional nodal metastases. Several nomograms and scoring systems have been created to predict the risk of metastasis in non-SLNs. The aim of the study was to identify individual patient risk for non-sentinel lymph node metastasis by validating with MSKCC nomogram and to evaluate the variability within a group of SLN-positive breast cancer patients with the final goal of avoiding unnecessary CALND. Patients and methods: We retrospectively evaluated 1496 primary breast cancer patients. 324 women with a positive SLN who underwent CALND were identified. The predictive accuracy was measured and compared with the MSKCC nomogram by the area under the receiver operating characteristic curve. Receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity, and the area under the curve (AUC) was calculated. Results: At least one metastatic non-SLN were identified in 88/324 (27.2%) patients. Tumor size, tumor type, tumor grade, number of positive SLNs and number of negative SLNs were significantly associated with non-SLN status in multivariate analyses. The MSKCC nomogram showed an AUC value of 0.738 (95% confidence interval=0.682-0.793) after the validation for our collectives. Conclusions: The MSKCC nomogram showed a good prediction for the non-SLN metastasis and performed adequately in our patient collective. Therefore, for the use of nomogram, validation with other populations of patients is strongly suggested.

AB - Background: Current guidelines for breast cancer treatment recommend completion axillary lymph node dissection (CALND) following in case of positive sentinel lymph node (SLN) metastasis, which only in 35%-70% shows additional nodal metastases. Several nomograms and scoring systems have been created to predict the risk of metastasis in non-SLNs. The aim of the study was to identify individual patient risk for non-sentinel lymph node metastasis by validating with MSKCC nomogram and to evaluate the variability within a group of SLN-positive breast cancer patients with the final goal of avoiding unnecessary CALND. Patients and methods: We retrospectively evaluated 1496 primary breast cancer patients. 324 women with a positive SLN who underwent CALND were identified. The predictive accuracy was measured and compared with the MSKCC nomogram by the area under the receiver operating characteristic curve. Receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity, and the area under the curve (AUC) was calculated. Results: At least one metastatic non-SLN were identified in 88/324 (27.2%) patients. Tumor size, tumor type, tumor grade, number of positive SLNs and number of negative SLNs were significantly associated with non-SLN status in multivariate analyses. The MSKCC nomogram showed an AUC value of 0.738 (95% confidence interval=0.682-0.793) after the validation for our collectives. Conclusions: The MSKCC nomogram showed a good prediction for the non-SLN metastasis and performed adequately in our patient collective. Therefore, for the use of nomogram, validation with other populations of patients is strongly suggested.

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