Related Experiment Video
Updated: Jun 5, 2025
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Declining Clinical Utility of Tools for Predicting Sentinel Lymph Node Biopsy Status: A Single Institution Experience
Harrison M Drebin1,2, Nicholas R Kurtansky3, Sharif Hosein3
1Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Introduction:
Clinicopathologic data-based sentinel lymph node (SLN) prediction models are used to select patients with melanoma for sentinel lymph node biopsy (SLNB). However, the temporal performance of these models is unknown. Therefore, we investigated whether the performance and clinical utility of the Melanoma Institute of Australia, Memorial Sloan Kettering Cancer Center, and Friedman et al. models changed over time.
Patients And Methods:
Primary cutaneous melanoma cases that underwent SLNB at a single tertiary-care cancer center from 2000 to 2021 were identified from a prospectively maintained database. Calibration plots were generated. Values for estimated risks of SLN positivity and area under the receiver operator curve (AUC) were calculated. Clinical utility was assessed at thresholds between 5 and 10% using decision curve analysis.
Results:
In total, 2977 SLNB cases were included. The estimated risk of SLN positivity and AUCs were similar across periods for all models. However, calibration decreased over time for all models, with progressive underprediction of SLN positivity. Clinical utility also declined over time; in the most recent period investigated (2018-2021), no model offered clinical utility at risk thresholds ≤ 8%, and only the Friedman model provided clinical utility at risk thresholds of 9-10%.
Conclusions:
The calibration and clinical utility of three predominant models for SLN prediction declined over time. There is a need to periodically reassess the performance of SLN prognostic tools as they are applied to contemporary cohorts. Future studies are needed to determine whether findings are generalizable outside of this study cohort.
