This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Smidt, M. L. Articles by Wobbes, T. Search for Related Content PubMed PubMed Citation Articles by Smidt, M. L. Articles by Wobbes, T.

Can Surgical Oncologists Reliably Predict the Likelihood for Non-SLN Metastases in Breast Cancer Patients?

¹ Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
² Departments of Medical Technology Assessment, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
³ Departments of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
⁴ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA

Correspondence: Address correspondence and reprint requests to: Marjolein L Smidt; Department of Surgical Oncology, Canisius Wilhelmina Hospital, PO Box 9015 6500 GS, Nijmegen, The Netherlands; E-mail: marjoleinsmidt{at}yahoo.com

Background: In approximately 40% of the breast cancer patients with sentinel lymph node (SLN) metastases, additional nodal metastases are detected in the completion axillary lymph node dissection (cALND). The MSKCC nomogram can help to quantify a patient’s individual risk for non-SLN metastases with fairly accurate predicted probability. The aim of this study was to compare the predictions of surgical oncologists for non-SLN metastases with nomogram results and to clarify the impact of nomogram results on clinical decision-making.

Methods: Questionnaires, containing patient scenarios, were sent to surgical oncologists involved in breast cancer care. The surgeon was asked to predict the probability for non-SLN metastases for the first five scenarios. For the remaining scenarios, the patient’s actuarial likelihood, calculated by the nomogram, was supplied. The surgeon was asked whether or not (s)he would perform a cALND. The type of hospital and the surgeon’s experience were registered.

Results: The concordance-index amounted to 0.78, indicating moderate concurrence between the surgical predictions and nomogram results. The intersurgeon variation was important. About 25% of the surgeons was influenced by nomogram information and decided in one or more patients to abandon the cALND. Neither the type of hospital nor experience influenced predicting abilities or the clinical decision-making process.

Conclusion: Individual predictions of surgical oncologists for non-SLN metastases do not correlate well with the MSKCC nomogram. The distribution between intersurgeon predictions for one scenario is important. Therefore, the nomogram is superior to clinical estimations for predicting the likelihood for non-SLN metastases.

Key Words: Breast neoplasms • Sentinel Lymph node biopsy • Lymphatic metastasis and risk assessment

This article has been cited by other articles:

				K. J. Van Zee and M. W. Kattan Validating a Predictive Model for Presence of Additional Disease in the Non Sentinel Lymph Nodes of a Woman with Sentinel Node Positive Breast Cancer Ann. Surg. Oncol., August 1, 2007; 14(8): 2177 - 2178. [Full Text] [PDF]