Nomogram for predicting preoperative lymph node involvement in patients with invasive micropapillary carcinoma of breast: a SEER population-based study

Abstract

BackgroundInvasive micropapillary carcinoma (IMPC) is an unusual and distinct subtype of invasive breast tumor with high propensity for regional lymph node metastases. This study was to identify risk factors accounting for IMPC of the breast and to develop a nomogram to preoperatively predict the probability of lymph node involvement.MethodsA retrospective review of the clinical and pathology records was performed in patients diagnosed with IMPC between 2003 and 2014 from Surveillance, Epidemiology, and End Results (SEER) database. The cohort was divided into training and validation sets. Training set comprised patients diagnosed between 2003 and 2009, while validation set included patients diagnosed thereafter. A logistic regression model was used to construct the nomogram in the training set and then varified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration using R 3.4.1 software.ResultsOverall, 1407 patients diagnosed with IMPC were enrolled, of which 527 in training set and 880 in validation set. Logistic regression analysis indicated larger lesions, younger age at diagnosis, black ethnic and lack of hormone receptor expression were significantly related to regional nodes involvement. The AUC of the nomogram was 0.735 (95% confidential interval (CI) 0.692 to 0.777), demonstrating a good prediction performance. Calibration curve for the nomogram was plotted and the slope was close to 1, which demonstrated excellent calibration of the nomogram. The performance of the nomogram was further validated in the validation set, with AUC of 0.748 (95% CI 0.701 to 0.767).ConclusionsThe striking difference between IMPC and IDC remains the increased lymph node involvement in IMPC and therefore merits aggressive treatment. The nomogram based on the clinicalpathologic parameters was established, which could accurately preoperatively predict regional lymph node status. This nomogram would facilitate evaluating lymph node state preoperatively and thus treatment decision-making of individual patients.

Nomogram for Predicting Preoperative Regional Lymph Nodes Metastasis in Patients with Metaplastic Breast Cancer: A SEER Population-Based Study

“…Gann PH et al studied data from 18,025 breast carcinoma cases and suggested tumors lacking ER had a signi cantly lower risk of LNM than tumors containing ER [40]. Additionally, Ye FG et al revealed ER status was an independently associated with a higher likelihood of LNM (OR = 5.254, 95% CI: 0.392-19.834, P < 0.014) [41]. Compared with the previous studies, we achieved a consistent conclusion.…”

Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

“…The predictive accuracy of the constructed nomogram was estimated using Harrell's concordance index (C-index) and the area below the time-dependent receiver operating characteristic curve (AUC). Calibration was assessed graphically by plotting the relationship between the predicted probability and the actual outcome using the Hosmer goodness-of-fit test [17]. The integrated discrimination improvement (IDI) and the net reclassification improvement (NRI) were calculated to evaluate the improved advantage in the predictive accuracy of the new prediction model [18]..…”

Bilateral Primary Breast Cancer: A Case Report and Literature Review

“…Due to the higher risk of LNM and recurrence in patients with IMPC, treatment should include wide surgical margins and adequate lymph node dissection, and conventional radiation therapy is considered to improve postoperative outcomes (16). Several prior studies (14)(15)(16)(17) reported the high rate of positivity of IMPC to ER, progesterone receptor (PR) and HER-2, which may indicate effectiveness of active endocrine therapy. Chen et al (4) reviewed 100 cases of invasive breast carcinoma with an IMPC component.…”