Probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound
This model includes ultrasound parameters to predict the probability of ALN metastasis in early breast cancer patients.
The model needs to be further validated before applying into clinical practice.
Research authors: Si-Qi Qiu, Huan-Cheng Zeng, Fan Zhang, Cong Chen, Wen-He Huang, Rick G Pleijhuis, Jun-Dong Wu, Gooitzen M van Dam, Guo-Jun Zhang.
  • Oncology
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Predicted probability of axillary metastasis:

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Conditional information

Model performance
In the modeling group (N=322), lymph node metastasis was detected in 163 (50.6%) patients. The model was well calibrated in the modeling group. Especially in the low predictive-probability subgroups, the model was found to provide a promising predictive value in early breast cancer patients. Hosmer-Lemeshow goodness-of-fit test indicated a good overall fit of the model (P-value: 0.18).

Validation:
The model developers performed an external validation on a separate cohort consisting of 234 patients. The calculated area under the ROC curve (c-index) for the validation group was 0.864, indicating good discriminative power of the model.

Predictors included in the model:
Tumor size and histological grade have been reported to be risk factors for ALN metastasis in many other studies (references included in original research paper). The current study confirmed these results. The predictive value of ER and PR status was uncertain in previous studies, with some studies showing no predictive value for ER and PR status and others reporting that lower risk of ALN metastasis was found in tumors with negative expression of either ER or PR. In the current study, ER overexpression was found to be associated with higher probability of ALN metastasis. This finding may be counterintuitive, but it was similar to the findings from Bevilacqua et al (2007). Although the reason of this phenomenon is unknown, it is hypothesized that ER negative tumors prefer hematogenous metastasis rather than lymphatic metastasis.

Model limitations:
Although the model showed good stability in the underlying study, it needs to be validated in more external validation groups to further evaluate its predictive ability.
Second, risk factors like clinical tumor size, cortical thickness and transverse diameter of lymph node may differ when measured by different doctors.

Source:
Qiu SQ, Zeng HC, Zhang F, et al. A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound. Sci Rep. 2016;6:21196.

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