Non-Sentinel Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node: Validation of Five Nomograms and Development of a New Predictive Model

Abstract

All the nomograms were good discriminators, but the alternative developed model showed the best predictive accuracy in this Italian breast cancer sample. We still confirm that these models, very accurate in the institution of origin, require a new validation if used on other populations of patients.

A Breast Cancer Nomogram for Prediction of Non-Sentinel Node Metastasis - Validation of Fourteen Existing Models

“…The main problem is determining which patients with positive SLNs should undergo completion ALND and which should not. To find a solution to this problem, predictive factors for non-SLN metastasis among patients with positive SLN have been investigated, and many nomograms or scoring systems have been developed to predict the likelihood of non-SLN metastasis using predictive factors (Van Zee et al, 2003;Degnim et al, 2005;Chapgar et al, 2006;Pal et al, 2008;Kohrt et al, 2008;Cho et al, 2008;Coufal et al, 2009;Gur et al, 2010;Perhavec et al, 2010;Lombardi, et al, 2011;Mittendorf et al, 2012;Meretoja et al, 2012;Derici et al, 2012).…”

“…Following the MSKCC model described by Van Zee et al, many models have been proposed and tested by many studies (Van Zee et al, 2003;Kocsis et al, 2004;Degnim et al, 2005;Smidt et al, 2005;Soni et al, 2005;Lambert et al, 2006;Alran et al, 2007;Ponzone et al, 2007;Cho et al,. 2008;Klar et al, 2008;Kohrt et al, 2008;Pal et al, 2008;Poirier et al, 2008;Coufal et al, 2009;Coutant et el., 2009;Scow et al, 2009;Gur et al, 2010;Moghaddam et al, 2010;Lombardi et al, 2011;Hessman et al, 2011;Hidar et al, 2011;Tan et al, 2011;Chen et al, 2012;Derici et al, 2012;Zhu et al, 2012;Sasada et al, 2013). The last proposed international model from multiple centers in Europe, however, has not been validated to date.…”

“…To avoid performing ALND for non-SLN-negative patients with SLN-positive axilla, nomograms and scoring systems for predicting the status of the axillary non-SLNs have been developed in many centers (Van Zee et al, 2003;Degnim et al, 2005;Smidt et al, 2005;Chapgar et al, 2006;Pal et al, 2008;Alran et al, 2007;Kohrt et al, 2008;Cho et al, 2008;Coufal et al, 2009;Gur et al, 2010;Perhavec et al, 2010;Lombardi, et al, 2011;Mittendorf et al, 2012;Meretoja et al, 2012;Derici et al, 2012). Many studies have tested these models and have obtained varying results (Van Zee et al, 2003;Kocsis et al, 2004;Degnim et al, 2005;Soni et al, 3 2005; Lambert et al, 2006;Ponzone et al, 2007;Pal et al, 2008;Kohrt et al, 2008;Cho et al, 2008;Klar et al, 2008;Poirier et al, 2008;Coufal et al, 2009;Coutant et el., 2009;Scow et al, 2009;Gur et al, 2010;Moghaddam et al, 2010;Hessman et al, 2011;Hidar et al, 2011;Lombardi et al, 2011;Tan et al, 2011;Derici et al, 2012;Chen et al, 2012;Zhu et al, 2012;Sasada et al, 2013).…”

“…Many studies have tested these models and have obtained varying results (Van Zee et al, 2003;Kocsis et al, 2004;Degnim et al, 2005;Soni et al, 3 2005; Lambert et al, 2006;Ponzone et al, 2007;Pal et al, 2008;Kohrt et al, 2008;Cho et al, 2008;Klar et al, 2008;Poirier et al, 2008;Coufal et al, 2009;Coutant et el., 2009;Scow et al, 2009;Gur et al, 2010;Moghaddam et al, 2010;Hessman et al, 2011;Hidar et al, 2011;Lombardi et al, 2011;Tan et al, 2011;Derici et al, 2012;Chen et al, 2012;Zhu et al, 2012;Sasada et al, 2013).…”

“…For this subgroup of patients, the use of nomograms could be unnecessary, but for patients beyond the scope of the ACOSOG Z0011 study and for patients who are candidates for mastectomy, it may still be important to predict the status of the nonSLNs. To the best of our knowledge, the present study is also the first to validate the Rome and European models other than by using the datasets reported in the original studies (Lombardi et al, 2011;Derici et al, 2012).…”