The number of positive axillary nodes is a strong prognostic factor in breast cancer, but is affected by variability in nodal staging technique yielding varying numbers of excised nodes. The nodal ratio of positive to excised nodes is an alternative that could address this variability. Our 2006 review found that the nodal ratio consistently outperformed the number of positive nodes, providing strong arguments for the use of nodal ratios in breast cancer staging and management. New evidence has continued to accrue confirming the prognostic significance of nodal ratios in various worldwide population settings. This review provides an updated summary of available data, and discusses the potential application of the nodal ratio to breast cancer staging and prognostication, its role in the context of modern surgical techniques such as sentinel node biopsy, and its potential correlations with new biologic markers such as circulating tumor cells and breast cancer stem cells.

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After completing this course, the reader will be able to:1. Identify changes in medical/surgical practice that can affect the prognostic performance of established prognostic factors such as lymph node involvement in breast cancer.2. Explain how the lymph node ratio can help to adjust against practice-related changes.3. Use the lymph node ratio as a measure of tumor burden in order to weigh the risk of breast cancer death against other causes of death in elderly patients.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTPurpose. The purpose of this article was to examine the relationship between age and lymph node ratio (LNR, number of positive nodes divided by number of examined nodes), and to determine their effects on breast cancer (BC) and overall mortality. The Oncologist CME Program is located online at http://cme.theoncologist.com/. Methods. Women aged >50 years, diagnosed in 1988 -To take the CME activity related to this article, you must be a registered user. Breast CancerThe

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Collaborative models of involving students in the co-construction of assessment rubrics are rare. Inviting students to take part actively in the design of assessment rubrics is one method of filling this research gap, garnering a shared understanding of assessment requirements. Rubrics traditionally are constructed by educators, based on set criteria, in order to streamline grading more cohesively and equitably. But research demonstrates that assessment rubric use is of more benefit to the educator in grading, than to the student in undertaking the assessment task-the educator understands requirements but specific requirements are not clear to the student. Using a multiple case study research approach incorporating a modified Delphi method to gather expert views on rubrics, the study outlined in this paper explores the outcomes of collaborating with creative writing students at the rubric design stage of the assessment process. This paper discusses the rubric co-construction process facilitated by a writing lecturer and a team of students from one university who took part in collaborating and developing a creative writing assessment rubric. The processes adopted to implement this co-construction are reported, the products of which