Nomograms for preoperative prediction of axillary nodal status in breast cancer

• Published in: British journal of surgery Vol. 104; no. 11; pp. 1494 - 1505
• Main Authors: Dihge, L., Bendahl, P.‐O., Rydén, L.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.10.2017; Oxford University Press
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Axilla; Biopsy; Breast cancer; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Cancer and Oncology; Cancer och onkologi; Carcinoma, Ductal, Breast - metabolism; Carcinoma, Ductal, Breast - pathology; Carcinoma, Lobular - metabolism; Carcinoma, Lobular - pathology; Clinical Decision-Making; Clinical Medicine; Female; Humans; Ki-67 Antigen - analysis; Kirurgi; Klinisk medicin; Lymph Node Excision; Lymph Nodes - pathology; Lymphatic Metastasis - diagnosis; Lymphatic system; Medical and Health Sciences; Medicin och hälsovetenskap; Metastasis; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Nomograms; Original; Preoperative Period; Receptor, ErbB-2 - metabolism; Registries; ROC Curve; Sentinel Lymph Node Biopsy; Surgery; Triple Negative Breast Neoplasms - pathology; Young Adult
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.10583

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. Defines need for staging?