Memorial Sloan-Kettering Cancer Center Nomogram Research Articles

Audit of pre-operative staging in the axilla in grade III breast cancer – is the Memorial Sloan-Kettering Cancer Centre nomogram a useful adjunct?

Audit of pre-operative staging in the axilla in grade III breast cancer – is the Memorial Sloan-Kettering Cancer Centre nomogram a useful adjunct?

Validation of a gastric cancer nomogram using a U.S. cancer registry.

13 Background: A Memorial Sloan Kettering Cancer Center (MSKCC) nomogram predicts disease−specific survival (DSS) following R0 resection for gastric adenocarcinoma using patient and tumor factors, with predictive ability superior to that of the current AJCC staging system. However, validation has only been performed in high−volume, specialized institutions. The goal of this study is to compare nomogram-predicted survival with actual survival by using a population database with the largest sample size reported to date. Methods: A retrospective review of all gastric cancer patients from Surveillance, Epidemiology and End Results (SEER) registry data from 1988 to 2000 was conducted. Data for patient age, tumor size, gender, primary location of tumor, Lauren histology, depth of tumor invasion, and % (+) and (-) lymph nodes was entered into the nomogram calculator for each patient. Nomogram-derived 5−year DSS was compared with actual DSS survival using Cox proportional hazards regression and Kaplan-Meier estimates. Results: 4,700 patients were identified. Mean patient age was 68.7 years (SD 12.3), and mean tumor size was 4.8 cm (SD 2.7). The commonest tumor location was the body/middle third of stomach (1519, 32%), followed by the gastro−esophageal junction (1381, 29%) and the antrum (1376, 29%). The majority of patients (76%) had intestinal histology. The estimated proportion of patients surviving 5 years was 23%, 48%, 58%, and 82% for survival groups defined by nomogram likelihoods of 5−year DSS of 0−25%, 26−50%, 51−75%, and 76−100%, respectively. Relative to patients in the 76−100% 5−year nomogram group, patients in the 0−25%, 26−50%, and 51−75% group had significantly higher likelihood of death with hazard ratios of 7.0 (95% CI 6.1−8.0), 3.3 (95% CI 2.8−4.0), and 2.6 (95% CI 2.2−3.0), respectively (all p<0.001). Median follow-up was 9.1 years (range, 0−18). The concordance index (c−index) for the 5−year nomogram score was 0.68 (95% CI 0.67−0.69). Conclusions: There is good discrimination of survival between nomogram-predicted survival groups. Our results validate the use of the MSKCC nomogram in the setting of the general population, outside of specialized institutions, for predicting DSS following resection of gastric adenocarcinoma.

Evaluation of a Breast Cancer Nomogram for Predicting Risk of Ipsilateral Breast Tumor Recurrences in Patients With Ductal Carcinoma in Situ After Local Excision

Prediction of patients at highest risk for ipsilateral breast tumor recurrence (IBTR) after local excision of ductal carcinoma in situ (DCIS) remains a clinical concern. The aim of our study was to evaluate a published nomogram from Memorial Sloan-Kettering Cancer Center to predict for risk of IBTR in patients with DCIS from our institution. We retrospectively identified 794 patients with a diagnosis of DCIS who had undergone local excision from 1990 through 2007 at the MD Anderson Cancer Center (MDACC). Clinicopathologic factors and the performance of the Memorial Sloan-Kettering Cancer Center nomogram for prediction of IBTR were assessed for 734 patients who had complete data. There was a marked difference with respect to tumor grade, prevalence of necrosis, initial presentation, final margins, and receipt of endocrine therapy between the two cohorts. The biggest difference was that more patients received radiation in the MDACC cohort (75% at MDACC v 49% at MSKCC; P < .001). Follow-up time in the MDACC cohort was longer than in the MSKCC cohort (median 7.1 years v 5.6 years), and the recurrence rate was lower in the MDACC cohort (7.9% v 11%). The median 5-year probability of recurrence was 5%, and the median 10-year probability of recurrence was 7%. The nomogram for prediction of 5- and 10-year IBTR probabilities demonstrated imperfect calibration and discrimination, with a concordance index of 0.63. Predictive models for IBTR in patients with DCIS who were treated with local excision are imperfect. Our current ability to accurately predict recurrence on the basis of clinical parameters alone is limited.

High Intersystem Variability for the Prediction of Additional Axillary Non-Sentinel Lymph Node Involvement in Individual Patients with Sentinel Node-Positive Breast Cancer

To compare the outcomes of the available systems that predict the risk of non-sentinel lymph node (non-SLN) metastasis and to evaluate the variability within a group of SLN-positive breast cancer patients. Predicted probabilities and scores for non-SLN metastasis were calculated with nine predictive systems for 120 SLN-positive patients who underwent a completion axillary lymph node dissection. The number of patients was calculated that were considered low risk or had a probability of ≤ 10% by at least one of the systems. For each nomogram, a box plot was constructed. All patients with a predicted probability of ≤ 10% according to the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram were selected, and a comparison was made with the probabilities predicted by the other systems. Nearly two-thirds (64.2%, n = 77) of patients with SLN-positive breast cancer were allocated to a low-risk or low-probability group by at least one of the predictive systems. No patients were uniformly classified as low risk by all nine prediction models. At the group level, a considerable variation in the distribution of the predicted probabilities was observed. At the individual level, calculation of the predicted probabilities for the selected patients who were considered low risk (≤ 10%) according to the MSKCC nomogram, showed even larger variations, ranging from 4 to 94%. This study shows that there is an unacceptably high variability in individual predictions when the predictive systems that are currently available are used to predict non-SLN metastasis in patients with SLN-positive breast cancer.

P3-07-35: Validation of Online Calculators To Predict Non-Sentinel Lymph Node Status in Sentinel Lymph Node-Positive Breast Cancer Patients.

Abstract Purpose: Axillary lymph node dissection (ALND) is recommended for breast cancer patients with sentinel lymph node (SLN) metastasis, but further nodal disease is not always present. Several models exist for predicting non-sentinel lymph node (non-SLN) metastasis in SLN metastasis. This study evaluated and compared the predictive values of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and the Stanford nomogram, which were conveniently available online, and clarified their usefulness for the micrometastasis or isolated tumor cell (ITC) subgroup. Methods: Data from 89 patients with positive SLN biopsy who underwent ALND were used, including 59 patients with macrometastasis and 30 with micrometastasis/ITC. The predicted probability of non-SLN metastasis was calculated using a computerized model from the websites for each nomogram. Results were compared using area under the curve (AUC) of the receiver operating characteristics curve for each model. False-negative and false-positive rates were also calculated. Results: AUC for the entire population was 0.701 with the MSKCC nomogram and 0.756 with the Stanford nomogram. AUCs of macrometastasis and micrometastasis/ITC were 0.680 and 0.469 with the MSKCC nomogram and 0.676 and 0.574 with the Stanford nomogram, respectively. Conclusions: This independent comparison found no significant difference between the two nomograms. In our results, these nomograms could not reliably predict positive non-SLN in cases with SLN micrometastasis/ITC. Further validation in other patient populations is needed. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-35.

P3-07-36: Predicting Sentinel Lymph Node Metastasis of a Chinese Breast Cancer Population: Assessment of an Existing Nomogram and a New Predictive Nomogram.

Abstract Background: The Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. In our study, The MSKCC nomogram performance for prediction of SLN metastases was assessed in Chinese breast cancer population. A new model (Shanghai Cancer Center Nomogram, SCC nomogram ) was developed with clinically relevant variables and possible advantages. Methods: Data were collected from 771 patients with successful SLN biopsy who were treated during March 2005 to June 2010. Touch imprint cytology (TIC) and serial section with H&amp;E staining were performed routinely on each sentinel node. 580 SLN biopsy procedures from March 2005to November 2009were used as training group to validate the MSKCC nomogram and assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The predictive accuracy of MSKCC nomogram was assessed by calculating the area under the receiver-operating characteristic (ROC) curve (AUC). The SCC nomogram was created from the logistic regression model. The new model was subsequently applied to 191 sequential SLN biopsies from January 2010 to June 2010 as the validation group. Results: It was shown that age, tumor size, tumor type, histological grade, lymphovascular invasion and neural invasion was correlated with the probability of SLN metastasis by univariate analysis (P&amp;lt;0.05). By multivariate analysis, tumor size, histological grade and lymphovascular invasion were identified as independent predictors of SLN metastasis. The SCC nomogram was then developed with four variables associated with SLN metastasis: age, tumor size, histological grade and lymphovascular invasion. The new model was accurate and discriminating, with AUC of 0.773 when applied to the validation group, as compared to the MSKCC nomogram with AUC of 0.754 in the modeling group. The trend of actual probability in various decile groups was comparable to the predicted probability. For predicted probability cut-off points of 7% and 15%, the false-negative rates of SCC nomogram were 0% and 8.1%. Conclusion: As far as we know, this is the first study designed to evaluate the MSKCC nomogram and develop a new nomogram in Chinese early breast cancer population. Compared to the MSKCC nomogram, the SCC nomogram was developed with similar AUC but less variables and lower false-negative rates for low-probability subgroups. It could provide a more acceptable clinical accessory in the preoperative discussion with patients, especially in the very low risk of patients. For those patients, the SCC nomogram could be used to safely avoid a SLN procedure, thereby reducing postoperative morbidity, whereas the rate could be as high as 7% in the literature. Although the SCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed well in Chinese breast cancer population, it is imperfect. The SCC nomogram was developed and validated in the single instite. The SCC model should be validated in different patient groups before it is demonstrated to be reproducible and would be applied widely. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-36.

Memorial Sloan-Kettering Cancer Center Nomogram to predict the risk of non-sentinel lymph node metastasis in Japanese breast cancer patients

Axillary lymph node dissection (ALND) remains the standard procedure for breast cancer patients with sentinel lymph node (SLN) metastasis; however, additional nodal metastasis is detected in completion ALND in only about 50% of these patients. To identify the risk of non-SLN metastasis, the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram. Many validation studies have been performed to evaluate the accuracy of the nomogram in Western populations, but not in Asians. We conducted this study to establish the accuracy of the nomogram in a Japanese population. The accuracy of the MSKCC nomogram for predicting non-SLN status was tested in 116 consecutive SLN-positive patients in our hospital. We then compared the findings of the source MSKCC study with those of our study. A receiver operating characteristics (ROC) curve was plotted, and the area under the curve (AUC) was calculated to assess the discriminative power. Despite the differences between our patients and the source population in many respects, the area under the ROC curve was 0.73, which was comparable to that obtained in the study on the source population. The MSKCC nomogram provides a fairly accurate predicted probability for the likelihood of non-SLN metastases. Accordingly, it served as a useful tool for our Japanese patients with SLN metastases.

Clinical Decision Aids in Colon Cancer: A Comparison of Two Predictive Nomograms

The risk of recurrence of colon cancer after curative surgery can be estimated by using decision aids. These aids use pathologic and patient factors to predict recurrence risk after adjuvant chemotherapy and have been validated when using clinical trial populations; however, the performance of 2 decision aids were compared by using a cohort of patients treated at a single center. Patient data were used to estimate the risk of recurrence when using both the Adjuvant! for colon cancer and Memorial Sloan Kettering Cancer Center (MSKCC) decision aids. A receiver operator characteristic (ROC) curve analyzed the predicted chance of being disease free at 5 years against the actual outcome for each patient. This curve was then used to define cutoff points at a chosen sensitivity and specificity to stratify patients into risk groups, and survival curves for each group calculated. Data on 134 patients were analyzed. The Pearson correlation between the 2 nomograms was 0.848 (P < .01). The ROC curve for the MSKCC nomogram had an area under the curve of 0.638. At a sensitivity and a specificity of 0.8, the MSKCC curve has a risk recurrence score of 69% and 84%, respectively. By using these cutoffs to stratify patients into 3 risk groups, a statistically significant difference in survival was found between high risk and low risk (P = .025). Tools to predict risk or recurrence and estimate benefit from therapy may be enhanced in the future by using genetic profiling, but use of existing tools can help deliver a personalized approach to adjuvant therapy.

Comparative Validation of Online Nomograms for Predicting Nonsentinel Lymph Node Status in Sentinel Lymph Node–Positive Breast Cancer

Completion axillary lymph node dissection is recommended for patients with metastases to the sentinel lymph node (SLN) in breast cancer although nonsentinel lymph nodes (NSLN) are often negative for tumor. Online nomograms are available to predict risk of NSLN disease. To compare the accuracy of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram (using 9 variables) with the Stanford nomogram (using 3 variables) in predicting NSLN metastasis. A single academic center. Prospectively maintained database of patients with breast cancer who underwent SLN biopsy from October 1, 1999, through January 31, 2008. Risk of NSLN metastasis was calculated using each nomogram's online calculator. Results from the axillary lymph node dissection were reviewed for positive NSLNs. Nomograms were evaluated using the area under the receiver operating characteristic curve, false-negative rates, positive predictive value, and calibration plot. Nomogram scores and axillary lymph node dissection results. Of 579 patients who underwent SLN biopsy, 179 (30.9%) had a positive SLN. For 123 patients who underwent axillary lymph node dissection, the area under the curve for the MSKCC and Stanford nomograms was 0.72 and 0.70, respectively. False-negative rates for nomogram values of 10% or less were low (4.1% for the MSKCC and 7.8% for the Stanford). The positive predictive value for nomogram probabilities of 80% or greater was higher for MSKCC than for Stanford (90.9% vs 61.8%). The Stanford nomogram performed more accurately in low-risk patients with isolated tumor cells or micrometastatic SLN disease; however, the MSKCC nomogram more accurately predicted NSLN outcomes across the entire study population. Although the MSKCC and Stanford nomograms performed similarly on the basis of the area under the curve, the MSKCC nomogram was consistently more reliable in predicting actual NSLN outcomes.

Maximizing the clinical usefulness of a nomogram to select patients candidate to sentinel node biopsy for cutaneous melanoma

Aims Investigators from the Memorial Sloan Kettering Cancer Centre (MSKCC) have proposed a nomogram for predicting the sentinel node (SN) status in patients with cutaneous melanoma. The negative predictive value (NPV) of this test, which might help identify low-risk patients who might be safely spared SN biopsy (SNB), has not been yet investigated. Methods We tested the discrimination (area under the curve [AUC]), the calibration (linear regression) and the NPV of MSKCC nomogram in 543 patients treated at our institution. Different cut-off values were tested to assess the NPV, the reduction of SNB performed and the overall error rate obtained with the MSKCC nomogram. Results SN was positive in 147 patients (27%). Mean predicted probability was 17.8% (95%CI: 16.8–18.8%). Nomogram discrimination was significant (area under the curve = 0.68; P < 0.0001) and mean predicted probabilities of SN positivity well correlated with the observed risk ( R 2 = 0.99). Cut-off values between 4% and 9% led to a NPV, SNB reduction and overall error rates ranging between 100 and 91.2%, 2.2 and 27.2%, and 0 and 2.3%, respectively. Conclusion In our series, the nomogram showed a significant predictive accuracy, although the incidence of SN metastasis was higher than that observed in the MSKCC series (27% vs 16%). Using the nomogram, a NPV greater than 90% could be obtained, which would be associated with a clinically meaningful reduction of the SNB rate and an acceptable error rate. If validated in large prospective series, this tool might be implemented in the clinical setting for SNB patient selection.

Axillary lymph node dissection in the case of sentinel lymph node micrometastatic invasion: evaluation of three predictive models

Objective To evaluate three predictive risk models of non-sentinel lymph node (NSLN) involvement in the case of micrometastatic sentinel node (SLN) involvement for breast cancer. Study design This retrospective study included 72 successive patients with micrometastatic SLN involvement who had surgery between March 1996 and October 2007. All patients had undergone immediate or delayed axillary lymph node dissection (ALND). The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram, the Stanford nomogram and the Tenon score were applied to the population to calculate the probability of NSLN involvement. Results For the MSKCC nomogram with a threshold value of 10%, sensitivity was 50%, specificity was 70% and the negative predictive value (NPV) was 89%. The area under the receiver operating characteristic curve (AUC) was 0.6 (significant). Use of this nomogram would have avoided ALND in 49 out of 72 (68%) patients, but five out of 10 (50%) patients with NSLN involvement would not have been detected. With a threshold value of 7%, the AUC was 0.69, sensitivity was 90% and NPV was 97%. ALND would have been avoided in 31 out of 72 (43%) patients, with a 3% chance of leaving metastases when abstaining from ALND. For the Tenon score with a threshold value of 3.5, sensitivity was 50%, specificity was 72% and the AUC was 0.62. This was not clinically applicable because eight out of 10 (80%) patients with NSLN involvement would not have been detected. For the Stanford nomogram, the results could not be interpreted because the AUC was not significant. Conclusion None of the tested models are sufficiently reliable for use in daily practice. The MSKCC nomogram showed the most encouraging results, especially for a threshold value of 7%, but this has not been validated in the literature. Complete axillary dissection should be performed in the case of micrometastatic SLN involvement until more data become available.

Comparison of two models for predicting non-sentinel lymph node metastases in sentinel lymph node-positive breast cancer patients

Several models for the prediction of non-sentinel lymph node (SLN) metastasis in SLN-positive breast cancer patients have been proposed. In this study, the authors evaluate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and an axilla scoring system from Tenon Hospital to predict the probability of having non-(SLN) involvement and to define their actual usefulness when applied to the subgroup of patients with micrometastasis in SLN. The study population consisted of 103 patients: 74 with macrometastasis and 29 with micrometastasis in the SLN. The receiver operating characteristic (ROC) curves were drawn and the area under the curves (AUCs) was calculated to assess the discriminative power of the nomograms. Both the ROCs and relative AUCs were calculated for all the patients in the study and for the two subgroups. The AUC for the entire study population was 0.712 in the MSKCC nomogram and 0.759 in the Tenon score. In 74 patients with macrometastasis in SLN, the AUC was 0.760 in MSKCC nomogram and 0.707 in Tenon score. Micrometastasis in SLN was found in t29 patients: AUC was 0.577 in the MSKCC nomogram and 0.738 in the Tenon score. Several institutions have tested the MSKCC nomogram, with AUC ranging from 0.58 to 0.84. It was not validated by four studies, which did not recommend its use in patients with micrometastasis. In our results, the validation of the Tenon score confirmed its relevance even in patients with micrometastasis in SLN.

Effect of Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram to avoid conventional axillary dissection of one node–metastasis Japanese patients with breast cancer.

e11531 Background: Our aim was to define the role of MSKCC nomogram in avoiding conventional axillary dissection of one node-metastasis breast cancer patients. Methods: Between January 2009 to November 2010, clinically axillary node negative consecutive 186 patients underwent sentinel lymph node biopsy using 12 mg Indigo carmine in our institution. Results: In 14 (7.5%) of the 186 cases with metastatic axillary nodes were node positive and underwent axillary dissection. Final pathological results shows 10 of 14 patients revealed one node-metastasis and four patients revealed more than 2 node-metastasis. Assessment of MSKCC nomogram, average of probability of spread to additional lymph node were 25.4% for the former group, 54% for the latter group. Conclusions: Our study confirms MSKCC nomogram’s role in sentinel lymph node biopsy of breast cancer surgery. MSKCC nomogram may prove useful in avoiding benefit from axillary dissection of only one node-metastasis breast cancer patients.

Evaluation of a selective management strategy of patients with primary cystic neoplasms of the pancreas

Background Recent studies have shown that a selective group of patients with primary cystic neoplasms of the pancreas can be managed conservatively by radiological follow-up. The aim of this study was to analyze if such a strategy is efficient and safe. Patients and methods A retrospective analyses was performed of patients who underwent resection between January 1992 and January 2006 for primary cystic neoplasms of the pancreas in an era of aggressive management (i.e. all patients underwent resection) in order to analyze if the selective algorithm as proposed by the Memorial Sloan-Kettering Cancer Center is efficient and safe. Results One hundred patients underwent a resection for pancreatic cysts. Thirty-five percent of the patients with symptomatic cysts had a (pre)malignant lesion compared with 15% of the patients with an incidental cysts. In hospital mortality occurred in 1% of the patients and a postoperative complications in 39%. The Memorial Sloan-Kettering Cancer Center nomogram was able to correctly identify all patients with a benign incidental cyst. Conclusion A selective management strategy can be implemented and algorithm proposed by the Memorial Sloan-Kettering Cancer Center nomogram is safe and efficient.

Abstract P1-01-07: Touch Imprint Cytology for Intraoperative Evaluation of Sentinel Lymph Node in Patients with Early-Stage Breast Cancer: A Five-Year Experience

Abstract Background: Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients for axillary lymph node dissection during the same operation and reduces the need for re-operation. Touch imprint cytology (TIC) serves as a main intraoperative assessment of SLNs in our institute for over five years. The purpose of the present study is to evaluate the clinical value of TIC as an intraoperative assessment for the diagnosis of SLN. Methods: Patients treated for early-stage breast cancer between Feb-2005 and May-2010 enrolled in the study. TIC was routinely performed intraoperatively, the result of which was correlated with definitive histological assessments of serial section with Hematoxylin-Eosin staining. Subsequent immunohistochemistry staining with CK-19 and MUC-1 were performed for research purposes. The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram was applied in this retrospective study to estimate probability of SLN involvement of each case. Results: A total of 1,077 patients with early-stage breast cancer enrolled in the study, and 3,048 SLNs were successfully harvested during the surgeries. Among those, 265 (24.6%) patients proved to have at least one SLN that was positive for carcinoma. Altogether, 397 (13.0%) involved nodes were removed from patients in the aforementioned patient pool. Based on the final pathology report, the sensitivity, specificity and overall accuracy of TIC was 83.4%, 99.0% and 95.2%, respectively on a per patient basis, and 78.3%, 99.4% and 96.7%, respectively on a per node basis. The sensitivity for macrometastasis and micrometastasis are 88.6% and 39.3%, respectively on a per patient basis, while 87.4% and 31. 3%, respectively on a per node basis. Of the patients included in this study, 98.7% had a positive SLN within their first three harvested SLNs. All the patients who were at a &amp;lt;10% chance of SLNs metastases according to the MSKCC nomogram were proved to be node negative by the final pathology. Conclusion: TIC is feasible and is able to detect macrometastasis in SLNs with an acceptable accuracy for clinical use in early-stage breast cancer patients while its ability to detect micrometastasis is limited. Limiting intraoperative TIC to the first three harvested SLNs in the diagnosis of SLN metastasis may make this diagnostic procedure significantly cheaper and easier for pathologists to perform. The MSKCC nomogram could be applied as a screening tool. Intraoperative assessment for SLNs, such as TIC, could be spared for patients with extremely low MSKCC scores (&amp;lt;10%). Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-07.

Abstract P1-01-20: Validation of MSKCC Nomogram in Predicting Sentinel Lymph Node Metastasis of a Chinese Breast Cancer Population

Abstract Background: The Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. Our study was designed to validate the clinical value of the MSKCC nomogram in Chinese early-stage breast cancer population. Methods: Data were collected from 524 patients with successful SLN biopsy who were treated during 2005 March to 2009 October. Positive SLN metastasis was found in 154 patients. Touch imprint cytology (TIC) and serial section with H&amp;E staining were performed routinely on each sentinel node. Univariate analysis and logistic regressions tested whether a characteristic was correlated with the SLN positivity. MSKCC nomogram was used to estimate probability of SLN involvement and compared with actual probability after grouping into deciles. A ROC curve was drawn and predictive accuracy was assessed by calculating the area under the receiver-operating characteristic (ROC) curve. Results: It was shown that age, tumor size, histological grade and lymphovascular invasion was correlated with the probability of SLN metastasis by univariate analysis (P&amp;lt;0.05). By multivariate analysis, tumor size and lymphovascular invasion were identified as independent predictors of SLN metastasis. The odds ratio (OR) of the lymphovascular invasion was 9.462(95% CI 5.551-16.130)while OR of tumor size was 1.429(95% CI 1.142-1.788). The trend of actual probability in various decile groups was comparable to the predicted probability. Patients in the group with the least probability of a positive SLN predicted by the nomogram (≥10 decile) were all diagnosed with a negative SLN by serial section by H&amp;E staining. Three patients in our collective with extremely high probability (≥90) were all diagnosed as positive SLN by pathology. The area under the ROC curve was 0.757 as compared to 0.754 in the original population. Conclusion: As far as we know, this is the first study designed to evaluated the MSKCC nomogram in Chinese early breast cancer population. The MSKCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed good in a Chinese breast cancer population. Though the nomogram cannot be an alternative of SLN biopsy, it could provide a clinical accessory in the preoperative discussion with patients, especially in the very high or very low risk of patients. The nomogram could be used in very low risk patients to safely avoid a SLN procedure, thereby reducing postoperative morbidity, whereas the rate could be as high as 7% in the literature. While for patients with very high risk estimated by the nomogram, axillary lymph node dissection could be recommended directly. The shortcoming of the nomogram is that clinical and pathological parameters include detail histological diagnosis of the primary tumor before the final decision for surgical procedure. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-20.

Sentinel Lymph Node Micrometastasis and Risk of Non–Sentinel Lymph Node Metastasis: Validation of Two Breast Cancer Nomograms

Introduction The aim of this study is to validate the predictive value of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and the Tenon score system in our sentinel lymph node (SLN)-positive series, and to define their actual usefulness when applied to the subgroup of patients with micrometastasis in SLN. Patients and Methods The study population consisted of 95 patients: 68 with macrometastasis and 27 with micrometastasis in the SLN. The predicted probability of non-SLN metastasis was calculated for each patient by using a computerized model from the MSKCC Web site. Furthermore, we have applied the Tenon score to our dataset. The receiver operating characteristic (ROC) curves were drawn and the areas under the curve (AUCs) were calculated to assess the discriminative power of the nomograms. The ROCs and relative AUCs were calculated both for all the patients in the study and for 2 subgroups. Results The AUC for the entire study population was 0.720 in MSKCC nomogram: and 0.754 in Tenon nomogram. In 68 patients with macrometastasis in SLN, the AUC was 0.760 in MSKCC nomogram and 0.707 in Tenon score. Micrometastasis in SLN were found in 27 patients: AUC was 0.595 in MSKCC nomogram and 0.734 in Tenon score. Conclusion In our results the MSKCC nomogram did not provide a reliable predictive model for identifying patients with low risk of non-SLN metastasis in the event of micrometastasis in SLN. Our validation study shows that the Tenon score is more accurate and useful in patients with micrometastasis in SLN.

Micrometastatic Disease and Isolated Tumor Cells as a Predictor for Additional Breast Cancer Axillary Metastatic Burden

Our study aims were to investigate breast cancer patients with micrometastases or isolated tumor cells (ITCs) in sentinel lymph nodes (SLNs) to determine the rate of non-SLN metastasis and axillary recurrences, and to compare actual non-SLN metastasis rates with those predicted by the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram. We identified 116 stage I to III breast cancer patients who underwent sentinel lymph node biopsy and had micrometastases or ITCs (<2-mm deposits). Patients underwent completion axillary lymph node dissection (ALND) (group 1) or had no further axillary surgery (group 2). P<0.05 was considered statistically significant. Of 116 patients with micrometastases or ITCs in SLNs, 55 (47%) underwent completion ALND (group 1), and 61 (53%) had no further axillary surgery (group 2). The rate of non-SLN metastases in group 1 patients was 9 (16%) of 55, which was significantly less than that predicted by the MSKCC nomogram (median 30%, P<0.001). Patient age, race, tumor histology, tumor grade, estrogen receptor/Her-2neu status, and lymphovascular invasion did not differ significantly between group 1 patients with positive non-SLNs and those with negative non-SLNs (P>0.05 for each), but patients with positive non-SLNs had larger tumors (P < 0.001). No patient in group 1 experienced an axillary recurrence, while only one patient (1.6%) in group 2 experienced axillary recurrence. The actual rate of positive non-SLNs for breast cancer patients with SLN micrometastases or ITCs who underwent completion ALND was significantly less than that predicted by the MSKCC nomogram. The rate of axillary recurrence is negligible, regardless of the extent of axillary staging.

Value of Memorial Sloan-Kettering Cancer Center nomogram in clinical decision making for sentinel lymph node-positive breast cancer

The aim of this study was to determine the value of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram for individual decision making in a Dutch cohort of women with breast cancer with a positive sentinel lymph node (SLN) but at low risk of additional nodal metastases. Data were collected on 168 patients with a positive SLN who underwent completion axillary lymph node dissection. The predicted probability of non-SLN metastases was calculated for each patient, using the MSKCC nomogram. Specificity and false-negative rates were calculated for subgroups with a predicted risk of no more than 5, 10 or 15 per cent. A receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) calculated. The discrimination of the MSKCC nomogram, measured by the AUC, was 0.68. For low predicted probability cut-off values of no more than 5, 10 and 15 per cent, the false-negative rates were 20, 14 and 19 per cent, and the specificities were 4, 27 and 32 per cent, respectively. The low-risk category (5 per cent or less) consisted of only 3.0 per cent of the study population. The performance of the MSKCC nomogram was insufficient to make it a useful tool for individual decision making in this cohort of women with SLN-positive breast cancer.

Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer

Women with breast cancer and a positive axillary sentinel lymph node (SLN) are recommended to undergo complete axillary lymph node dissection; however, further nodal disease is not always present. Mathematical models have been constructed to determine the risk of metastatic disease; three of these were evaluated independently. Data from 108 women with breast cancer who had a positive SLN biopsy and completion axillary lymph node dissection were used. Measurements of additional parameters over those usually determined (such as size of SLN metastasis) were assessed under the supervision of two pathologists. These data were used to determine the predicted risk of non-SLN metastases using three mathematical models (from Memorial Sloan-Kettering Cancer Center (MSKCC), Cambridge University and Stanford University) and a comparison made with the observed findings. Analyses were made using the area under the receiver operating characteristic (ROC) curve (AUC). Some 53 (49.1 per cent) of 108 patients had a positive non-sentinel axillary lymph node metastasis. The AUC values were 0.63, 0.72 and 0.67 for the MSKCC, Cambridge and Stanford nomograms respectively. This independent comparison found no significant difference between the models, although the Cambridge model had the advantage of requiring fewer measurements with a more accurate predictive performance.