Klar M, Jochmann A, Foeldi M, Stumpf M, Gitsch G, Stickeler E, Watermann D
Department of Obstetrics and Gynecology, University of Freiburg, Medical School, Freiburg, Germany.
Breast Cancer Res Treat. 2008 Dec;112(3):523-31. doi: 10.1007/s10549-007-9884-1. Epub 2008 Jan 3.
To assess whether the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram for prediction of NSLN metastasis is useful in a German breast cancer population and whether the characteristics of the breast tumor and the sentinel lymph node (SLN) are able to predict the likelihood of non-sentinel lymph node (NSLN) metastasis.
A total of 545 patients with primary breast cancer and SLN examination were evaluated. The MSKCC nomogram was applied to 98 patients with a positive SLN who subsequently had completion axillary lymph node dissection (ALND). Predictive accuracy was assessed by calculating the area under the receiver-operator characteristic (ROC) curve. The collective was evaluated by correlating the prevalence of NSLN and SLN metastasis to pathological features.
The MSKCC nomogram achieved a ROC of 0.58 indicating a bad accuracy of the nomogram. Tumor size, histology, lymphovascular infiltration, multifocality, Her-2-neu positivity, and nuclear grade correlated with the probability of SLN metastasis. Histology and primary tumor localization correlated significantly with the probability of NSLN metastasis.
The MSKCC nomogram did not provide a reliable predictive model in our study population. However, the likelihood of SLN metastasis correlated with the presumed risk factors and no obvious differences between the MSKCC population and our population could be seen. In order to achieve interinstitutional reproducibility, standardization of surgical procedure and of the pathological assessment of the SLN is desirable.
评估纪念斯隆凯特琳癌症中心（MSKCC）用于预测非前哨淋巴结转移的列线图在德国乳腺癌人群中是否有用，以及乳腺肿瘤和前哨淋巴结（SLN）的特征能否预测非前哨淋巴结（NSLN）转移的可能性。
共评估了545例接受原发性乳腺癌和SLN检查的患者。MSKCC列线图应用于98例SLN阳性且随后进行了腋窝淋巴结清扫术（ALND）的患者。通过计算受试者操作特征（ROC）曲线下面积评估预测准确性。通过将NSLN和SLN转移的发生率与病理特征相关联来评估总体情况。
MSKCC列线图的ROC为0.58，表明该列线图准确性较差。肿瘤大小﹑组织学类型﹑淋巴管浸润﹑多灶性﹑Her-2-neu阳性以及核分级与SLN转移的可能性相关。组织学类型和原发肿瘤定位与NSLN转移的可能性显著相关。
在我们的研究人群中，MSKCC列线图未提供可靠的预测模型。然而，SLN转移的可能性与假定的风险因素相关，且在MSKCC人群和我们的人群之间未发现明显差异。为了实现机构间的可重复性，手术操作和SLN病理评估的标准化是可取的。
