A Comparison of Breast Surgeon and Nomogram-Generated Risk Predictions of Sentinel and Non-Sentinel Node Metastases

Luisa Sugaya,José Luiz B Bevilacqua,Paulo R De Alcantara Filho,Sujata Patil,Kimberly J Van Zee,Bruna Salani Mota

doi:10.4236/jct.2013.47a001

Abstract

Memorial Sloan-Kettering Cancer Center (MSKCC) has developed 2 nomograms: the Sentinel Lymph Node Nomogram (SLNN), which is used to predict the likelihood of sentinel lymph node (SLN) metastases in patients with invasive breast cancer, and the Non-Sentinel Lymph Node Nomogram (NSLNN), which is used to predict the likelihood of residual axillary disease after a positive SLN biopsy. Our purpose was to compare the accuracy of MSKCC nomogram predictions with those made by breast surgeons. Two questionnaires were built with characteristics of two sets of 33 randomly selected patients from the MSKCC Sentinel Node Database. The first included only patients with invasive breast cancer, and the second included only patients with invasive breast cancer and positive SLN biopsy. 26 randomly selected Brazilian breast surgeons were asked about the probability of each patient in the first set having SLN metastases and each patient in the second set having additional non-SLN metastases. The predictions of the nomograms and breast surgeons were compared. There was no correlation between nomogram risk predictions and breast surgeon risk prediction estimates for either the SLNN or the NSLNN. The area under the receiver operating characteristics curves (AUCs) were 0.871 and 0.657 for SLNN and breast surgeons, respectively (p 0.0001), and 0.889 and 0.575 for the NSLNN and breast surgeons, respectively (p 0.0001). The nomograms were significantly more accurate as prediction tools than the risk predictions of breast surgeons in Brazil. This study demonstrates the potential utility of both nomograms in the decision-making process for patients with invasive breast cancer.

Highlights

Over the last decades, public awareness, medical education, and increased use of screening mammography have resulted in earlier detection and treatment of invasive breast cancer, greatly improving the prognosis of those patients [1,2]
Memorial Sloan-Kettering Cancer Center (MSKCC) has developed 2 nomograms: the Sentinel Lymph Node Nomogram (SLNN), which is used to predict the likelihood of sentinel lymph node (SLN) metastases in patients with invasive breast cancer, and the Non-Sentinel Lymph Node Nomogram (NSLNN), which is used to predict the likelihood of residual axillary disease after a positive SLN biopsy
When predicting the likelihood of a patient having SLN metastases, the area under the receiver operating characteristics curves (AUCs)-ROC achieved by the MSKCC nomograms was 0.871 (Figure 3)

Summary

Introduction

Public awareness, medical education, and increased use of screening mammography have resulted in earlier detection and treatment of invasive breast cancer, greatly improving the prognosis of those patients [1,2]. The adoption of sentinel lymph node biopsy (SLNB) has allowed those with no axillary metastases to avoid axillary lymph node dissection (ALND), and has reduced morbidity as a result. Since the adoption of SLNB to stage the axilla, the standard management of a positive. Only 40% - 50% of patients with positive sentinel lymph nodes (SLNs) who undergo completion axillary lymph node dissection (cALND) have additional non-SLN metastases, with favorable subsets of women having an even lower risk of non-SLN metastases. Women without residual nodal disease are unlikely to benefit from cALND, but are exposed to the risk of lymphedema and other morbidities. A recent randomized controlled trial of cALND (American College of Surgeons Oncology Group [ACOSOG] Z0011) was carried out in a selected group of clinically node-negative women with early-stage breast cancer undergoing breast-conserving surgery and whole breast radiation, with positive SLN.

Methods

Results

Conclusion