Klar M, Foeldi M, Markert S, Gitsch G, Stickeler E, Watermann D
Department of Obstetrics and Gynecology, University of Freiburg, Medical School, Freiburg, Germany.
Ann Surg Oncol. 2009 May;16(5):1136-42. doi: 10.1245/s10434-009-0399-3. Epub 2009 Mar 4.
The sentinel lymph node (SLN) procedure could be omitted in cases of accurate prediction of very high or very low probability of SLN metastasis in early breast cancer patients. We evaluated a breast cancer nomogram, an online tool provided by the Memorial Sloan-Kettering Cancer Center (MSKCC), that predicts the likelihood of a positive lymph node.
Data from 545 patients with successful SLN biopsy were collected, including 118 patients with a positive sentinel lymph node. Histopathological assessment of the SLN included hematoxylin and eosin staining and/or immunohistochemistry. Predictive accuracy was assessed by calculating the area under the receiver-operator characteristic (ROC) curve.
In our collective tumor size, histology, lymphovascular infiltration, multifocality, Her-2-neu positivity, and nuclear grade correlated with the probability of SLN metastasis. The ROC of the validated nomogram in our breast cancer population revealed a value of 0.78 compared with 0.75 in the original publication.
The MSKCC nomogram is a useful tool in our population of breast cancer patients. However, variations in the pathological assessment of the SLN between breast cancer centers worldwide might be an impediment to widespread application of the nomogram.
在早期乳腺癌患者中，若能准确预测前哨淋巴结（SLN）转移的概率非常高或非常低，则可省略前哨淋巴结活检程序。我们评估了一种乳腺癌列线图，这是纪念斯隆凯特琳癌症中心（MSKCC）提供的一种在线工具，可预测淋巴结转移阳性的可能性。
收集了545例行前哨淋巴结活检成功患者的数据，其中118例前哨淋巴结阳性。前哨淋巴结的组织病理学评估包括苏木精和伊红染色及/或免疫组织化学。通过计算受试者工作特征（ROC）曲线下面积评估预测准确性。
在我们的总体研究中，肿瘤大小、组织学类型、淋巴管浸润、多灶性、人表皮生长因子受体2（Her-2-neu）阳性及核分级与前哨淋巴结转移概率相关。在我们的乳腺癌人群中，经过验证的列线图的ROC值为0.78，而原始发表文章中的值为0.75。
MSKCC列线图在我们的乳腺癌患者群体中是一种有用的工具。然而，全球各乳腺癌中心在前哨淋巴结病理评估方面的差异可能会阻碍列线图的广泛应用。
