Probability of axillary lymph node metastasis in breast cancer patients
Probability of axillary lymph node metastasis in breast cancer patients.

Note: This model consists of 4 different submodels. After selection of the patient-specific characteristics, the corresponding model formula is automatically selected. 
Research authors: Qiu S, Aarnink M, Maaren van MC, Dorius MD, Bhattacharya A, Veltman J, Klazen CAH, Korte JH, Estourgie SH, Ott P, Kelder W, Zeng HC, Koffijberg H, Zhang GJ, Dam van GM, Siesling S
Details Custom formula Study characteristics Files & References
★★
Model author
Model ID
999
Version
1.43
Revision date
2018-10-19
Specialty
MeSH terms
  • Lymph Nodes
  • Axilla
  • Breast Cancer
  • Lymphatic Metastases
  • Ultrasonography
  • Model type
    Custom model (Conditional)
    Status
    public
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    Condition Formula

    Additional information

    PURPOSE: This study aimed to validate and update a model for predicting the risk of axillary lymph node (ALN) metastasis for assisting clinical decision-making.

    METHODS: We included breast cancer patients diagnosed at six Dutch hospitals between 2011 and 2015 to validate the original model which includes six variables: clinical tumor size, tumor grade, estrogen receptor status, lymph node longest axis, cortical thickness and hilum status as detected by ultrasonography. Subsequently, we updated the original model using generalized linear model (GLM) tree analysis and by adjusting its intercept and slope. The area under the receiver operator characteristic curve (AUC) and calibration curve were used to assess the original and updated models. Clinical usefulness of the model was evaluated by false-negative rates (FNRs) at different cut-off points for the predictive probability.

    RESULTS: Data from 1416 patients were analyzed. The AUC for the original model was 0.774. Patients were classified into four risk groups by GLM analysis, for which four updated models were created. The AUC for the updated models was 0.812. The calibration curves showed that the updated model predictions were better in agreement with actual observations than the original model predictions. FNRs of the updated models were lower than the preset 10% at all cut-off points when the predictive probability was less than 12.0%.

    CONCLUSIONS: The original model showed good performance in the Dutch validation population. The updated models resulted in more accurate ALN metastasis prediction and could be useful preoperative tools in selecting low-risk patients for omission of axillary surgery.

    Study Population

    Total population size: 0

    Additional characteristics

    No additional characteristics defined

    Related files

    Supporting Publications

    Probability of axillary lymph node metastasis:
    ...
    %

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    Result
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    Probability of axillary lymph node metastasis: %

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this model should be used:
    This model calculates the probability of axillary lymph node metastasis in breast cancer patients.

    Model validation and updating:
    At total of 1416 breast cancer patients diagnosed at six Dutch hospitals between 2011 and 2015 were used to externally validate the original model, which was published previously.1,2 Subsequently, the original model was updated using generalized linear model (GLM) tree analysis and by adjusting its intercept and slope.1

    Model performance:
    The AUC for the original model was 0.774.2 Patients were classified into four risk groups by GLM analysis, for which four updated models were created.1 The AUC for the updated models was 0.812. The calibration curves showed that the updated model predictions were better in agreement with actual observations than the original model predictions. FNRs of the updated models were lower than the preset 10% at all cut-off points when the predictive probability was less than 12.0%.

    References:

    1. Qiu S, Aarnink M, van Maaren MC, et al. Validation and update of a lymph node metastasis prediction model for breast cancer. Eur J Surg Oncol. 2018;44(5):700-707.
    2. S.Q. Qiu, H.C. Zeng, F. Zhang. 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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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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