In the study, our aim was to evaluate the predictability of four different nomograms
on non-sentinel lymph node metastases (NSLNM) in breast cancer (BC) patients with
positive sentinel lymph node (SLN) biopsy in a multi-center study.
We identified 607 patients who had a positive SLN biopsy and completion axillary lymph
node dissection (CALND) at seven different BC treatment centers in Turkey. The BC
nomograms developed by the Memorial Sloan Kettering Cancer Center (MSKCC), Tenon Hospital,
Cambridge University, and Stanford University were used to calculate the probability
of NSLNM. Area under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated
for each nomogram and values greater than 0.70 were accepted as demonstrating good
discrimination.
Two hundred and eighty-seven patients (287) of 607 patients (47.2%) had a positive
axillary NSLNM. The AUC values were 0.705, 0.711, 0.730, and 0.582 for the MSKCC,
Cambridge, Stanford, and Tenon models, respectively. On the multivariate analysis;
overall metastasis size (OMS), lymphovascular invasion (LVI), and proportion of positive
SLN to total SLN were found statistically significant. We created a formula to predict
the NSLNM in our patient population and the AUC value of this formula was 0.8023.
The MSKCC, Cambridge, and Stanford nomograms were good discriminators of NSLNM in
SLN positive BC patients in this study. A newly created formula in this study needs
to be validated in prospective studies in different patient populations. A nomogram
to predict NSLNM in patients with positive SLN biopsy developed at one institution
should be used with caution.
Copyright (c) 2009 Elsevier Ltd. All rights reserved.