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SAN FRANCISCO – The distance of a breast cancer from a woman’s nipple added to the ability of nomograms to predict sentinel lymph node positivity, based on a study of data from 401 breast cancers.
The data came from 395 patients who had clinical stage T1 (85% of the cohort) or T2 tumors and underwent prebiopsy ultrasounds at the Mayo Clinic, Rochester, Minn. The investigators performed a second review of the images to measure the tumors’ distance from the nipple.
Nomograms published online by the Memorial Sloan-Kettering Cancer Center and by the University of Texas M.D. Anderson Cancer Center do a reasonably good job of discriminating which newly diagnosed breast cancer patients who have not undergone neoadjuvant therapy are likely to have positive and negative sentinel nodes. Using those two nomograms alone on the patients in the study produced an area under the curve (AUC) of 0.71 for the Memorial Sloan-Kettering nomogram and 0.74 for the M.D. Anderson nomogram. Adding a tumor-to-nipple distance of 2 cm or less improved the AUCs to 0.73 and 0.76, respectively, Dr. Miraj Shah-Khan and her coinvestigators reported.
Sentinel lymph nodes were positive in 20% of the 401 tumors; 17 of 33 tumors within 2 cm of the nipple had positive sentinel lymph nodes (52%), compared with 17% of 368 tumors farther than 2 cm from the nipple, Dr. Shah-Khan, of the Medical College of Wisconsin, Milwaukee, and her associates reported in a poster presented at a breast cancer symposium sponsored by the American Society of Clinical Oncology.
In each subgroup of probability predicted by the nomograms, tumor-to-nipple distance helped to refine the probability of a positive node.
When the Memorial Sloan-Kettering nomogram predicted less than a 25% chance of node positivity, adding a tumor-to-nipple distance of 2 cm or less changed the probability to 35%, compared with 11% if the distance was greater than 2 cm. A probability of 25%-49% from the same nomogram changed to 62% if a tumor was within 2 cm of the nipple or 29% for tumors farther from the nipple. A probability of 50% or greater from the nomogram changed to 100% if a tumor was within 2 cm of the nipple or 32% if it was farther away.
When the M.D. Anderson nomogram predicted less than a 25% chance of node positivity, adding a tumor-to-nipple distance of 2 cm or less changed the probability to 42%, compared with 14% if the distance was greater than 2 cm. A probability of 25%-49% from the same nomogram changed to 83% if a tumor was within 2 cm of the nipple or 40% for tumors farther from the nipple. A probability of 50% or greater from the nomogram changed to 100% if a tumor was within 2 cm of the nipple or 67% if it was farther away, she reported.
The symposium was cosponsored by the American Society of Breast Disease, the American Society of Breast Surgeons, the National Consortium of Breast Centers, the Society of Surgical Oncology, and the American Society for Radiation Oncology.
Dr. Shah-Khan reported having no financial disclosures.
On Twitter @sherryboschert
The Mayo Clinic group has previously proposed that the tumor’s distance from the nipple is a predictive factor of whether there is tumor in the sentinel node. There are data showing that the distance from the nipple affects the positivity rate.
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This study factors in the M.D. Anderson and the Memorial Sloan-Kettering nomograms to create a more robust model for predicting sentinel node positivity. The distance from the nipple and the distance from the skin, when used in addition to the nomogram, increase the predictive ability.
If you are a user of nomograms or if you are a selective user of nomograms for some patients with invasive breast cancer who are still on the fence about whether or not they should undergo a sentinel node procedure, this additional measure gives you a bit more ability to predict the positivity rate with more certainty. I’m a very selective user of nomograms because the individual patient in front of me is not a statistic. For me, nomograms become useful only for those patients who are fence-sitters. It is not a routine part of my practice.
Dr. David W. Ollila is a professor of surgical oncology at the University of North Carolina, Chapel Hill. He reported having no financial disclosures.
The Mayo Clinic group has previously proposed that the tumor’s distance from the nipple is a predictive factor of whether there is tumor in the sentinel node. There are data showing that the distance from the nipple affects the positivity rate.
|
|
This study factors in the M.D. Anderson and the Memorial Sloan-Kettering nomograms to create a more robust model for predicting sentinel node positivity. The distance from the nipple and the distance from the skin, when used in addition to the nomogram, increase the predictive ability.
If you are a user of nomograms or if you are a selective user of nomograms for some patients with invasive breast cancer who are still on the fence about whether or not they should undergo a sentinel node procedure, this additional measure gives you a bit more ability to predict the positivity rate with more certainty. I’m a very selective user of nomograms because the individual patient in front of me is not a statistic. For me, nomograms become useful only for those patients who are fence-sitters. It is not a routine part of my practice.
Dr. David W. Ollila is a professor of surgical oncology at the University of North Carolina, Chapel Hill. He reported having no financial disclosures.
The Mayo Clinic group has previously proposed that the tumor’s distance from the nipple is a predictive factor of whether there is tumor in the sentinel node. There are data showing that the distance from the nipple affects the positivity rate.
|
|
This study factors in the M.D. Anderson and the Memorial Sloan-Kettering nomograms to create a more robust model for predicting sentinel node positivity. The distance from the nipple and the distance from the skin, when used in addition to the nomogram, increase the predictive ability.
If you are a user of nomograms or if you are a selective user of nomograms for some patients with invasive breast cancer who are still on the fence about whether or not they should undergo a sentinel node procedure, this additional measure gives you a bit more ability to predict the positivity rate with more certainty. I’m a very selective user of nomograms because the individual patient in front of me is not a statistic. For me, nomograms become useful only for those patients who are fence-sitters. It is not a routine part of my practice.
Dr. David W. Ollila is a professor of surgical oncology at the University of North Carolina, Chapel Hill. He reported having no financial disclosures.
SAN FRANCISCO – The distance of a breast cancer from a woman’s nipple added to the ability of nomograms to predict sentinel lymph node positivity, based on a study of data from 401 breast cancers.
The data came from 395 patients who had clinical stage T1 (85% of the cohort) or T2 tumors and underwent prebiopsy ultrasounds at the Mayo Clinic, Rochester, Minn. The investigators performed a second review of the images to measure the tumors’ distance from the nipple.
Nomograms published online by the Memorial Sloan-Kettering Cancer Center and by the University of Texas M.D. Anderson Cancer Center do a reasonably good job of discriminating which newly diagnosed breast cancer patients who have not undergone neoadjuvant therapy are likely to have positive and negative sentinel nodes. Using those two nomograms alone on the patients in the study produced an area under the curve (AUC) of 0.71 for the Memorial Sloan-Kettering nomogram and 0.74 for the M.D. Anderson nomogram. Adding a tumor-to-nipple distance of 2 cm or less improved the AUCs to 0.73 and 0.76, respectively, Dr. Miraj Shah-Khan and her coinvestigators reported.
Sentinel lymph nodes were positive in 20% of the 401 tumors; 17 of 33 tumors within 2 cm of the nipple had positive sentinel lymph nodes (52%), compared with 17% of 368 tumors farther than 2 cm from the nipple, Dr. Shah-Khan, of the Medical College of Wisconsin, Milwaukee, and her associates reported in a poster presented at a breast cancer symposium sponsored by the American Society of Clinical Oncology.
In each subgroup of probability predicted by the nomograms, tumor-to-nipple distance helped to refine the probability of a positive node.
When the Memorial Sloan-Kettering nomogram predicted less than a 25% chance of node positivity, adding a tumor-to-nipple distance of 2 cm or less changed the probability to 35%, compared with 11% if the distance was greater than 2 cm. A probability of 25%-49% from the same nomogram changed to 62% if a tumor was within 2 cm of the nipple or 29% for tumors farther from the nipple. A probability of 50% or greater from the nomogram changed to 100% if a tumor was within 2 cm of the nipple or 32% if it was farther away.
When the M.D. Anderson nomogram predicted less than a 25% chance of node positivity, adding a tumor-to-nipple distance of 2 cm or less changed the probability to 42%, compared with 14% if the distance was greater than 2 cm. A probability of 25%-49% from the same nomogram changed to 83% if a tumor was within 2 cm of the nipple or 40% for tumors farther from the nipple. A probability of 50% or greater from the nomogram changed to 100% if a tumor was within 2 cm of the nipple or 67% if it was farther away, she reported.
The symposium was cosponsored by the American Society of Breast Disease, the American Society of Breast Surgeons, the National Consortium of Breast Centers, the Society of Surgical Oncology, and the American Society for Radiation Oncology.
Dr. Shah-Khan reported having no financial disclosures.
On Twitter @sherryboschert
SAN FRANCISCO – The distance of a breast cancer from a woman’s nipple added to the ability of nomograms to predict sentinel lymph node positivity, based on a study of data from 401 breast cancers.
The data came from 395 patients who had clinical stage T1 (85% of the cohort) or T2 tumors and underwent prebiopsy ultrasounds at the Mayo Clinic, Rochester, Minn. The investigators performed a second review of the images to measure the tumors’ distance from the nipple.
Nomograms published online by the Memorial Sloan-Kettering Cancer Center and by the University of Texas M.D. Anderson Cancer Center do a reasonably good job of discriminating which newly diagnosed breast cancer patients who have not undergone neoadjuvant therapy are likely to have positive and negative sentinel nodes. Using those two nomograms alone on the patients in the study produced an area under the curve (AUC) of 0.71 for the Memorial Sloan-Kettering nomogram and 0.74 for the M.D. Anderson nomogram. Adding a tumor-to-nipple distance of 2 cm or less improved the AUCs to 0.73 and 0.76, respectively, Dr. Miraj Shah-Khan and her coinvestigators reported.
Sentinel lymph nodes were positive in 20% of the 401 tumors; 17 of 33 tumors within 2 cm of the nipple had positive sentinel lymph nodes (52%), compared with 17% of 368 tumors farther than 2 cm from the nipple, Dr. Shah-Khan, of the Medical College of Wisconsin, Milwaukee, and her associates reported in a poster presented at a breast cancer symposium sponsored by the American Society of Clinical Oncology.
In each subgroup of probability predicted by the nomograms, tumor-to-nipple distance helped to refine the probability of a positive node.
When the Memorial Sloan-Kettering nomogram predicted less than a 25% chance of node positivity, adding a tumor-to-nipple distance of 2 cm or less changed the probability to 35%, compared with 11% if the distance was greater than 2 cm. A probability of 25%-49% from the same nomogram changed to 62% if a tumor was within 2 cm of the nipple or 29% for tumors farther from the nipple. A probability of 50% or greater from the nomogram changed to 100% if a tumor was within 2 cm of the nipple or 32% if it was farther away.
When the M.D. Anderson nomogram predicted less than a 25% chance of node positivity, adding a tumor-to-nipple distance of 2 cm or less changed the probability to 42%, compared with 14% if the distance was greater than 2 cm. A probability of 25%-49% from the same nomogram changed to 83% if a tumor was within 2 cm of the nipple or 40% for tumors farther from the nipple. A probability of 50% or greater from the nomogram changed to 100% if a tumor was within 2 cm of the nipple or 67% if it was farther away, she reported.
The symposium was cosponsored by the American Society of Breast Disease, the American Society of Breast Surgeons, the National Consortium of Breast Centers, the Society of Surgical Oncology, and the American Society for Radiation Oncology.
Dr. Shah-Khan reported having no financial disclosures.
On Twitter @sherryboschert
AT THE ASCO BREAST CANCER SYMPOSIUM
Major finding: Positive sentinel nodes were seen in 17 of 33 (52%) tumors within 2 cm of the nipple, compared with 17% of 368 tumors more than 2 cm from the nipple.
Data source: A second review of prebiopsy ultrasound images of 401 clinical T1 or T2 breast cancer tumors in 395 patients and comparison with nomograms for predicting sentinel node positivity.
Disclosures: Dr. Shah-Khan reported having no financial disclosures.
