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Nomograms for preoperative prediction of axillary nodal status in breast cancer

Dihge, L. LU ; Bendahl, P. O. LU and Rydén, Lisa LU (2017) In British Journal of Surgery
Abstract

Background: Axillary staging in patients with breast cancer and clinically node-negative disease is performed by sentinel node biopsy (SLNB). The aim of this study was to integrate feasible preoperative variables into nomograms to guide clinicians in stratifying treatment options into no axillary staging for patients with non-metastatic disease (N0), SLNB for those with one or two metastases, and axillary lymph node dissection (ALND) for patients with three or more metastases. Methods: Patients presenting to Skåne University Hospital, Lund, with breast cancer were included in a prospectively maintained registry between January 2009 and December 2012. Those with a preoperative diagnosis of nodal metastases were excluded. Patients with... (More)

Background: Axillary staging in patients with breast cancer and clinically node-negative disease is performed by sentinel node biopsy (SLNB). The aim of this study was to integrate feasible preoperative variables into nomograms to guide clinicians in stratifying treatment options into no axillary staging for patients with non-metastatic disease (N0), SLNB for those with one or two metastases, and axillary lymph node dissection (ALND) for patients with three or more metastases. Methods: Patients presenting to Skåne University Hospital, Lund, with breast cancer were included in a prospectively maintained registry between January 2009 and December 2012. Those with a preoperative diagnosis of nodal metastases were excluded. Patients with data on hormone receptor status, human epidermal growth factor receptor 2 and Ki-67 expression were included to allow grouping into surrogate molecular subtypes. Based on logistic regression analyses, nomograms summarizing the strength of the associations between the predictors and each nodal status endpoint were developed. Predictive performance was assessed using the area under the receiver operating characteristic (ROC) curve. Bootstrap resampling was performed for internal validation. Results: Of the 692 patients eligible for analysis, 248 were diagnosed with node-positive disease. Molecular subtype, age, mode of detection, tumour size, multifocality and vascular invasion were identified as predictors of any nodal disease. Nomograms that included these predictors demonstrated good predictive abilities, and comparable performances in the internal validation; the area under the ROC curve was 0·74 for N0 versus any lymph node metastasis, 0·70 for one or two involved nodes versus N0, and 0·81 for at least three nodes versus two or fewer metastatic nodes. Conclusion: The nomograms presented facilitate preoperative decision-making regarding the extent of axillary surgery.

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publication status
epub
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in
British Journal of Surgery
publisher
John Wiley & Sons
external identifiers
  • scopus:85024929330
ISSN
0007-1323
DOI
10.1002/bjs.10583
language
English
LU publication?
yes
id
baa2c216-b99f-46f8-a5db-ff31f1cd61f1
date added to LUP
2017-08-30 11:41:59
date last changed
2017-08-31 03:00:02
@article{baa2c216-b99f-46f8-a5db-ff31f1cd61f1,
  abstract     = {<p>Background: Axillary staging in patients with breast cancer and clinically node-negative disease is performed by sentinel node biopsy (SLNB). The aim of this study was to integrate feasible preoperative variables into nomograms to guide clinicians in stratifying treatment options into no axillary staging for patients with non-metastatic disease (N0), SLNB for those with one or two metastases, and axillary lymph node dissection (ALND) for patients with three or more metastases. Methods: Patients presenting to Skåne University Hospital, Lund, with breast cancer were included in a prospectively maintained registry between January 2009 and December 2012. Those with a preoperative diagnosis of nodal metastases were excluded. Patients with data on hormone receptor status, human epidermal growth factor receptor 2 and Ki-67 expression were included to allow grouping into surrogate molecular subtypes. Based on logistic regression analyses, nomograms summarizing the strength of the associations between the predictors and each nodal status endpoint were developed. Predictive performance was assessed using the area under the receiver operating characteristic (ROC) curve. Bootstrap resampling was performed for internal validation. Results: Of the 692 patients eligible for analysis, 248 were diagnosed with node-positive disease. Molecular subtype, age, mode of detection, tumour size, multifocality and vascular invasion were identified as predictors of any nodal disease. Nomograms that included these predictors demonstrated good predictive abilities, and comparable performances in the internal validation; the area under the ROC curve was 0·74 for N0 versus any lymph node metastasis, 0·70 for one or two involved nodes versus N0, and 0·81 for at least three nodes versus two or fewer metastatic nodes. Conclusion: The nomograms presented facilitate preoperative decision-making regarding the extent of axillary surgery.</p>},
  author       = {Dihge, L. and Bendahl, P. O. and Rydén, Lisa},
  issn         = {0007-1323},
  language     = {eng},
  publisher    = {John Wiley & Sons},
  series       = {British Journal of Surgery},
  title        = {Nomograms for preoperative prediction of axillary nodal status in breast cancer},
  url          = {http://dx.doi.org/10.1002/bjs.10583},
  year         = {2017},
}