Validation of Nomograms for Predicting Non-Sentinel Lymph Node Metastases in Patients with Sentinel Lymph Node Biopsy in a New Zealand Population
Sentinel node biopsy (SNB) is an integral part of breast cancer management. 1 Previously a positive SNB has led to a completion axillary lymph node dissection (ALND), however, studies have demonstrated that nearly 60% of these patients do not have non-sentinel lymph node metastases (NSLNM), thus receiving a non-therapeutic ALND and being exposed to its associated risks. 2-3 As such, several nomograms have been developed and validated to predict the risk of NSLNM in order to avoid an unnecessary ALND, although none so far has been done for an Australasian population.4 It is important to establish whether the nomograms are sufficiently accurate for use in our population to guide management. We will validate two nomograms from the Memorial Sloane Kettering Cancer Centre and MD Anderson Cancer Centre against 185 patients from June 2009 to June 2015 in the Christchurch Breast Cancer Patient Register. The receiver operating curve and area under the curve will be derived from the nomogram calculators and compared with the observed incidence of NSLNM in this population. The results and a discussion of the findings will be presented.
Albertini JJ, Lyman GH, Cox C, et al. 1996. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA, 276(22): 1818-1822.
Kim T, Giuliano AE, Lyman GH. 2006. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer, 106(1): 4-16.
Giuliano AE, Hunt KK, Ballman KV, et al. 2011. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA, 305(6): 569-575.
Moghaddam Y, Falzon M, Fulford L, et al. 2010. Comparison of three mathematical models for predicting the risk of additional axillary nodal metastases after positive sentinel lymph node biopsy in early breast cancer. Br J Surg, 97(11): 1646-1652.