Annals of Surgical Oncology

, Volume 12, Issue 12, pp 1066–1072 | Cite as

Can the Memorial Sloan-Kettering Cancer Center Nomogram Predict the Likelihood of Nonsentinel Lymph Node Metastases in Breast Cancer Patients in The Netherlands?

  • Marjolein L. Smidt
  • Deborah M. Kuster
  • Gert Jan van der Wilt
  • Frederik B. Thunnissen
  • Kimberley J. Van Zee
  • Luc J. A. Strobbe



According to Dutch guidelines, an axillary lymph node dissection (ALND) is recommended whenever a sentinel lymph node (SLN) contains metastatic disease. However, only in approximately 50% of patients with metastatic disease in the SLN are additional nodal metastases detected in the completion ALND. To identify the individual patient’s risk for non-SLN metastases, a nomogram containing eight predictors was developed by the Breast Service of Memorial Sloan-Kettering Cancer Center (New York, NY). The aim of this study was to test the accuracy of the nomogram on a population of Dutch breast cancer patients.


Patient, tumor, and SLN metastasis characteristics were collected for 222 consecutive patients who underwent a completion ALND. The data of the index and test populations were compared. A receiver operating characteristic curve was drawn, and the area under the curve was calculated to assess the discriminative power of the nomogram.


Even though our patient population differed in many respects from the source population, the area under the receiver operating characteristic curve amounted to .77, a value very much comparable to the one found in the source population.


The nomogram provides a fairly accurate predicted probability for the likelihood of non-SLN metastases in a general population of breast cancer patients at a regional teaching hospital in The Netherlands. This suggests that the nomogram’s originally calculated predictive accuracy may be valid for patient populations that differ considerably from the population in which it was developed.


Breast neoplasms Sentinel lymph node biopsy Nomogram Axillary metastases Prediction 



The authors thank J. M. M. Groenewoud of the Department of Medical Technology Assessment, Radboud University Medical Centre, for statistical support.


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Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Marjolein L. Smidt
    • 1
  • Deborah M. Kuster
    • 1
  • Gert Jan van der Wilt
    • 2
  • Frederik B. Thunnissen
    • 3
  • Kimberley J. Van Zee
    • 4
  • Luc J. A. Strobbe
    • 1
  1. 1.Department of Surgical OncologyC22, Canisius Wilhelmina HospitalThe Netherlands
  2. 2.Department of Medical Technology AssessmentRadboud University Medical CentreNijmegenThe Netherlands
  3. 3.Department of PathologyCanisius Wilhelmina HospitalNijmegenThe Netherlands
  4. 4.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew York

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