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Are Breast Cancer Nomograms Still Valid to Predict the Need for Axillary Dissection?
Vilma Madekivi1, Antti Karlsson2, Pia Boström3
1Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland, vlmade@utu.fi.
Background:
Nomograms can help in estimating the nodal status among clinically node-negative patients. Yet their validity in external cohorts over time is unknown. If the nodal stage can be estimated preoperatively, the need for axillary dissection can be decided.
Objectives:
The aim of this study was to validate three existing nomograms predicting 4 or more axillary lymph node metastases.
Method:
The risk for ≥4 lymph node metastases was calculated for n = 529 eligible breast cancer patients using the nomograms of Chagpar et al. [Ann Surg Oncol. 2007;14:670-7], Katz et al. [J Clin Oncol. 2008;26(13):2093-8], and Meretoja et al. [Breast Cancer Res Treat. 2013;138(3):817-27]. Discrimination and calibration were calculated for each nomogram to determine their validity.
Results:
In this cohort, the AUC values for the Chagpar, Katz, and Meretoja models were 0.79 (95% CI 0.74-0.83), 0.87 (95% CI 0.83-0.91), and 0.82 (95% CI 0.76-0.86), respectively, showing good discrimination between patients with and without high nodal burdens.
Conclusion:
This study presents support for the use of older breast cancer nomograms and confirms their current validity in an external population.
