Abstract:
Objective: In the study, our aim was to evaluate the predictability of four different nomograms on non-sentinel lymph node metastases
(NSLNM) in breast cancer (BC) patients with positive sentinel lymph node (SLN) biopsy in a multi-center study.
Methods: We identified 607 patients who had a positive SLN biopsy and completion axillary lymph node dissection (CALND) at seven
different BC treatment centers in Turkey. The BC nomograms developed by the Memorial Sloan Kettering Cancer Center (MSKCC), Tenon
Hospital, Cambridge University, and Stanford University were used to calculate the probability of NSLNM. Area under (AUC) Receiver
Operating Characteristics Curve (ROC) was calculated for each nomogram and values greater than 0.70 were accepted as demonstrating
good discrimination.
Results: Two hundred and eighty-seven patients (287) of 607 patients (47.2%) had a positive axillary NSLNM. The AUC values were 0.705,
0.711, 0.730, and 0.582 for the MSKCC, Cambridge, Stanford, and Tenon models, respectively. On the multivariate analysis; overall
metastasis size (OMS), lymphovascular invasion (LVI), and proportion of positive SLN to total SLN were found statistically significant.
We created a formula to predict the NSLNM in our patient population and the AUC value of this formula was 0.8023.
Conclusions: The MSKCC, Cambridge, and Stanford nomograms were good discriminators of NSLNM in SLN positive BC patients in this
study. A newly created formula in this study needs to be validated in prospective studies in different patient populations. A nomogram to
predict NSLNM in patients with positive SLN biopsy developed at one institution should be used with caution.
