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Originally published as Ann Surg Oncol Early Release 10.1245/ASO.2003.03.015 on November 10, 2003

Annals of Surgical Oncology 10:1140-1151 (2003)
© 2003 Society of Surgical Oncology
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ORIGINAL ARTICLES

A Nomogram for Predicting the Likelihood of Additional Nodal Metastases in Breast Cancer Patients With a Positive Sentinel Node Biopsy

Kimberly J. Van Zee, MS, MD, Donna-Marie E. Manasseh, MD, Jose L. B. Bevilacqua, MD, Susan K. Boolbol, MD, Jane V. Fey, MPH, Lee K. Tan, MD, Patrick I. Borgen, MD, Hiram S. Cody, III, MD and Michael W. Kattan, PhD

From the Departments of Surgery (KJVZ, DMEM, JLBB, SKB, JVF, PIB, HSC), Pathology (LKT), and Urology, Epidemiology and Biostatistics (MWK), Memorial Sloan-Kettering Cancer Center, New York, New York.

Correspondence: Address correspondence and reprint requests to: Kimberly J. Van Zee, MS, MD, FACS, 1275 York Ave., MRI-1026, New York, NY 10021; Fax: 212-794–5812; E-mail: vanzeek{at}mskcc.org

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.

Key Words: Axillary metastases • Breast cancer • Nomogram • Prediction • Sentinel node




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