Advertisement

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
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Breast neoplasms Sentinel lymph node biopsy Nomogram Axillary metastases Prediction 

Notes

Acknowledgments

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

References

  1. 1.
    Fisher B, Bauer M, Wickerham DL, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer 1983;52:1551–6PubMedGoogle Scholar
  2. 2.
    Turner RR, Ollila DW, Krasne DL, Giuliano AE. Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 1997;226:271–7CrossRefPubMedGoogle Scholar
  3. 3.
    Veronesi U. The sentinel node and breast cancer. Br J Surg 1999;86:1–2CrossRefPubMedGoogle Scholar
  4. 4.
    Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet 1997;349:1864–7CrossRefPubMedGoogle Scholar
  5. 5.
    Giuliano AE, Haigh PI, Brennan MB, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer. J Clin Oncol 2000;18:2553–9PubMedGoogle Scholar
  6. 6.
    Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998;339:941–6CrossRefPubMedGoogle Scholar
  7. 7.
    O’Hea BJ, Hill AD, El Shirbiny AM, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg 1998;186:423–7PubMedGoogle Scholar
  8. 8.
    Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546–53CrossRefPubMedGoogle Scholar
  9. 9.
    Fisher B, Redmond C, Fisher ER, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985;312:674–81PubMedGoogle Scholar
  10. 10.
    Greco M, Agresti R, Cascinelli N, et al. Breast cancer patients treated without axillary surgery: clinical implications and biologic analysis. Ann Surg 2000;232:1–7CrossRefPubMedGoogle Scholar
  11. 11.
    Orr RK. The impact of prophylactic axillary node dissection on breast cancer survival—a Bayesian meta-analysis. Ann Surg Oncol 1999;6:109–16CrossRefPubMedGoogle Scholar
  12. 12.
    Harris JR, Osteen RT. Patients with early breast cancer benefit from effective axillary treatment. Breast Cancer Res Treat 1985;5:17–21PubMedGoogle Scholar
  13. 13.
    Moore MP, Kinne DW. Axillary lymphadenectomy: a diagnostic and therapeutic procedure. J Surg Oncol 1997;66:2–6CrossRefPubMedGoogle Scholar
  14. 14.
    American Joint Committee on Cancer. Breast. In: AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag, 2002:221–40Google Scholar
  15. 15.
    Cady B. Case against axillary lymphadenectomy for most patients with infiltrating breast cancer. J Surg Oncol 1997;66:7–10CrossRefPubMedGoogle Scholar
  16. 16.
    Weiser MR, Montgomery LL, Tan LK, et al. Lymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg Oncol 2001;8:145–9PubMedGoogle Scholar
  17. 17.
    Fant JS, Grant MD, Knox SM, et al. Preliminary outcome analysis in patients with breast cancer and a positive sentinel lymph node who declined axillary dissection. Ann Surg Oncol 2003;10:126–30CrossRefPubMedGoogle Scholar
  18. 18.
    Rouzier R, Extra JM, Klijanienko J, et al. Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 2002;20:1304–10CrossRefPubMedGoogle Scholar
  19. 19.
    Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 2003;10:1140–51CrossRefPubMedGoogle Scholar
  20. 20.
    Abdessalam SF, Zervos EE, Prasad M, et al. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg 2001;182:316–20CrossRefPubMedGoogle Scholar
  21. 21.
    Bevilacqua J, Cody H, MacDonald KA, Tan LK, Borgen PI, Van Zee KJ. A prospective validated model for predicting axillary node metastases based on 2,000 sentinel node procedures: the role of tumour location. Eur J Surg Oncol 2002;28:490–500PubMedGoogle Scholar
  22. 22.
    Chu KU, Turner RR, Hansen NM, Brennan MB, Bilchik A, Giuliano AE. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 1999;229:536–41CrossRefPubMedGoogle Scholar
  23. 23.
    Grube BJ, Hansen NM, Ye X, Giuliano AE. Tumor characteristics predictive of sentinel node metastases in 105 consecutive patients with invasive lobular carcinoma. Am J Surg 2002;184:372–6CrossRefPubMedGoogle Scholar
  24. 24.
    Hwang RF, Krishnamurthy S, Hunt KK, et al. Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer. Ann Surg Oncol 2003;10:248–54PubMedGoogle Scholar
  25. 25.
    Port ER, Tan LK, Borgen PI, Van Zee KJ. Incidence of axillary lymph node metastases in T1a and T1b breast carcinoma. Ann Surg Oncol 1998;5:23–7PubMedGoogle Scholar
  26. 26.
    Rahusen FD, Torrenga H, Van Diest PJ, et al. Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg 2001;136:1059–63PubMedGoogle Scholar
  27. 27.
    Sachdev U, Murphy K, Derzie A, Jaffer S, Bleiweiss IJ, Brower S. Predictors of nonsentinel lymph node metastasis in breast cancer patients. Am J Surg 2002;183:213–7CrossRefPubMedGoogle Scholar
  28. 28.
    Travagli JP, Atallah D, Mathieu MC, et al. Sentinel lymphadenectomy without systematic axillary dissection in breast cancer patients: predictors of non-sentinel lymph node metastasis. Eur J Surg Oncol 2003;29:403–6CrossRefPubMedGoogle Scholar
  29. 29.
    Viale G, Maiorano E, Mazzarol G, et al. Histologic detection and clinical implications of micrometastases in axillary sentinel lymph nodes for patients with breast carcinoma. Cancer 2001;92:1378–84CrossRefPubMedGoogle Scholar
  30. 30.
    Kamath VJ, Giuliano R, Dauway EL, et al. Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. Arch Surg 2001;136:689–92Google Scholar
  31. 31.
    Degnim AC, Griffith KA, Sabel MS, et al. Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer 2003;98:2307–15CrossRefPubMedGoogle Scholar
  32. 32.
    Specht MC, Kattan MW, Gonen M, Fey J, Van Zee KJ. Predicting nonsentinel node status after positive sentinel lymph biopsy for breast cancer: clinicians versus nomogram. Ann Surg Oncol 2005;12:654–9CrossRefPubMedGoogle Scholar
  33. 33.
    Smidt ML, Janssen CMM, Kuster DM, Bruggink EDM, Strobbe LJA. Axillary recurrence after a negative sentinel node biopsy for breast cancer: incidence and clinical significance. Ann Surg Oncol 2005;12:29–33CrossRefPubMedGoogle Scholar

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

Personalised recommendations