Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Surg Oncol. 2023 Jun;127(7):1167-1173. doi: 10.1002/jso.27231. Epub 2023 Mar 11.
The Melanoma Institute of Australia (MIA) and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms were developed to help guide sentinel lymph node biopsy (SLNB) decisions. Although statistically validated, whether these prediction models provide clinical benefit at National Comprehensive Cancer Network guideline-endorsed thresholds is unknown. We conducted a net benefit analysis to quantify the clinical utility of these nomograms at risk thresholds of 5%-10% compared to the alternative strategy of biopsying all patients. External validation data for MIA and MSKCC nomograms were extracted from respective published studies.
The MIA nomogram provided added net benefit at a risk threshold of 9% but net harm at 5%-8% and 10%. The MSKCC nomogram provided added net benefit at risk thresholds of 5% and 9%-10% but net harm at 6%-8%. When present, the magnitude of net benefit was small (1-3 net avoidable biopsies per 100 patients).
Neither model consistently provided added net benefit compared to performing SLNB for all patients.
Based on published data, use of the MIA or MSKCC nomograms as decision-making tools for SLNB at risk thresholds of 5%-10% does not clearly provide clinical benefit to patients.
澳大利亚黑色素瘤研究所（MIA）和纪念斯隆凯特琳癌症中心（MSKCC）的列线图旨在帮助指导前哨淋巴结活检（SLNB）决策。尽管经过统计学验证，但这些预测模型在国家综合癌症网络指南认可的阈值下是否提供临床获益尚不清楚。我们进行了净收益分析，以量化在 5%-10%的风险阈值下，这些列线图相对于对所有患者进行活检的替代策略的临床实用性。从各自发表的研究中提取了 MIA 和 MSKCC 列线图的外部验证数据。
MIA 列线图在风险阈值为 9%时提供了额外的净收益，但在 5%-8%和 10%时则带来了净损害。MSKCC 列线图在风险阈值为 5%和 9%-10%时提供了额外的净收益，但在 6%-8%时则带来了净损害。如果存在净收益，则其幅度较小（每 100 例患者中可避免 1-3 例活检）。
与对所有患者进行 SLNB 相比，两种模型均未一致提供额外的净收益。
根据已发表的数据，在 5%-10%的风险阈值下，使用 MIA 或 MSKCC 列线图作为 SLNB 的决策工具并不能为患者提供明确的临床获益。
