Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
Br J Dermatol. 2021 Aug;185(2):412-418. doi: 10.1111/bjd.19895. Epub 2021 May 9.
A nomogram to predict sentinel node (SN) positivity [the Melanoma Institute Australia (MIA) nomogram] was recently developed and externally validated using two large single-institution databases. However, there remains a need to further validate the nomogram's performance using population-based data.
To perform further validation of the nomogram using a European national patient cohort.
Patients with cutaneous melanoma who underwent SN biopsy in the Netherlands between 2000 and 2014 were included. Their data were obtained from the Dutch Pathology Registry. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. Negative predictive values (NPVs) were calculated at various predicted probability cutoffs.
Of the 3049 patients who met the eligibility criteria, 23% (691) were SN positive. Validation of the MIA nomogram (including the parameters Breslow thickness, ulceration, age, melanoma subtype and lymphovascular invasion) showed a good C-statistic of 0·69 (95% confidence interval 0·66-0·71) with excellent calibration (R = 0·985, P = 0·40). The NPV of 90·1%, found at a 10% predicted probability cutoff for having a positive SN biopsy, implied that by using the nomogram, a 16·3% reduction in the rate of performing an SN biopsy could be achieved with an error rate of 1·6%. Validation of the MIA nomogram considering mitotic rate as present or absent showed a C-statistic of 0·70 (95% confidence interval 0·68-0·74).
This population-based validation study in European patients with melanoma confirmed the value of the MIA nomogram in predicting SN positivity. Its use will spare low-risk patients the inconvenience, cost and potential risks of SN biopsy while ensuring that high-risk patients are still identified.
最近开发了一种用于预测前哨淋巴结（SN）阳性的列线图[澳大利亚黑色素瘤研究所（MIA）列线图]，并使用两个大型单机构数据库对其进行了外部验证。然而，仍然需要使用基于人群的数据进一步验证该列线图的性能。
使用欧洲国家患者队列对列线图进行进一步验证。
纳入 2000 年至 2014 年间在荷兰接受 SN 活检的皮肤黑色素瘤患者。他们的数据来自荷兰病理学登记处。通过判别（C 统计量）和校准评估列线图的预测性能。在不同预测概率截止值下计算阴性预测值（NPV）。
符合入选标准的 3049 例患者中，23%（691 例）SN 阳性。MIA 列线图（包括 Breslow 厚度、溃疡、年龄、黑色素瘤亚型和脉管侵犯）的验证显示，其 C 统计量为 0.69（95%置信区间 0.66-0.71），校准良好（R = 0.985，P = 0.40）。在预测概率为 10%的 SN 活检阳性的截断值下，NPV 为 90.1%，这意味着通过使用该列线图，可以将 SN 活检的实施率降低 16.3%，错误率为 1.6%。考虑有丝分裂率存在或不存在时，MIA 列线图的验证显示 C 统计量为 0.70（95%置信区间 0.68-0.74）。
这项针对欧洲黑色素瘤患者的基于人群的验证研究证实了 MIA 列线图在预测 SN 阳性方面的价值。它的使用将使低风险患者免受 SN 活检的不便、成本和潜在风险，同时确保识别出高风险患者。
