Raza Vishal Farid, Ehsan Ayesha, Khan Amina Iqbal
Shaukat Khanum Memorial Cancer Hospital and Research Center, FCPS General Surgery, Lahore, Punjab, Pakistan.
Shaukat Khanum Memorial Cancer Hospital and Research Center, FACS, Lahore, Punjab, Pakistan.
Inquiry. 2025 Jan-Dec;62:469580251366150. doi: 10.1177/00469580251366150. Epub 2025 Aug 21.
Axillary surgery in breast cancer has evolved from radical dissections to selective de-escalations. Identifying patients who may safely omit sentinel lymph node biopsy (SLNB) can further reduce the surgical burden, post operative complications and financial toxicity associated with breast cancer surgical care. The MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" is widely available and free of charge to assess SLNB positivity post neoadjuvant chemotherapy (NACT). This study externally validates its accuracy in a sample of Pakistani women and assesses its implications for cost effective breast cancer care in a resource limited setting. Retrospective chart review of 150 women who underwent axillary sentinel lymph node biopsy post NACT at Shaukat Khanum Memorial Cancer Hospital from January 2023 to August 2024. Predicted node probability and observed positivity on histopathology were recorded. Calibration (Hosmer-Lemeshow test) and discrimination (C-index) were calculated. 98% were ductal carcinomas; tumor sub-types showed luminal A (42.7%), luminal B (4.7%), her2neu (H2N) enriched (14%) and triple negative (TNBC; 38.7%). 18% (n = 27) nodes were positive on final pathology closely aligning with the nomogram's predicted probability of 17.1 ± 10.3%. Calibration showed good model fit ( = .89) while C-index (0.64) indicated moderate discrimination. 12.6% of women would avoid costs of SLNB if omitted in the 0% to 5% bracket and 31.3% of women in the 0% to 10% bracket. TNBC demonstrated lowest positivity of 6.89% ( = .01). The MD Anderson Clinical Calculator for predicting positive sentinel lymph nodes post NACT may have a role in tailoring decisions for axillary de-escalation especially in patients with a low probability score between 0% and 10% with decrease in costs of breast cancer care in LMICs. Future studies incorporating safety of axillary surgery omission using the calculator and its economic impact are warranted.
乳腺癌腋窝手术已从根治性切除发展为选择性的降阶梯手术。识别那些可以安全省略前哨淋巴结活检（SLNB）的患者，能够进一步减轻与乳腺癌手术治疗相关的手术负担、术后并发症及经济负担。MD安德森癌症中心的“新辅助化疗后预测前哨淋巴结阳性的列线图”广泛可用且免费，用于评估新辅助化疗（NACT）后SLNB的阳性情况。本研究在巴基斯坦女性样本中对其准确性进行了外部验证，并评估了其在资源有限环境下对具有成本效益的乳腺癌护理的影响。对2023年1月至2024年8月在沙卡特汗姆纪念癌症医院接受NACT后进行腋窝前哨淋巴结活检的150名女性进行回顾性病历审查。记录预测的淋巴结概率和组织病理学观察到的阳性情况。计算校准（Hosmer-Lemeshow检验）和区分度（C指数）。98%为导管癌；肿瘤亚型显示为管腔A型（42.7%）、管腔B型（4.7%）、her-2neu（H2N）富集型（14%）和三阴性（TNBC；38.7%）。最终病理显示18%（n = 27）的淋巴结阳性，与列线图预测的概率17.1 ± 10.3%密切相符。校准显示模型拟合良好（ = 0.89），而C指数（0.64）表明区分度中等。如果在0%至5%区间省略SLNB，12.6%的女性可避免相关费用；在0%至10%区间，31.3%的女性可避免相关费用。TNBC的阳性率最低，为6.89%（ = 0.01）。MD安德森癌症中心用于预测NACT后前哨淋巴结阳性的临床计算器，可能在制定腋窝降阶梯决策中发挥作用，特别是对于概率评分在0%至10%之间的低概率患者，可降低低收入和中等收入国家乳腺癌护理的成本。有必要开展未来研究，纳入使用该计算器省略腋窝手术的安全性及其经济影响。
