Validation of a Breast Cancer Nomogram for Predicting Nonsentinel Lymph Node Metastases after a Positive Sentinel Node Biopsy

Excerpt

We have read with interest the letter by Dr. Soran et al. concerning our article published in the March 2006 issue of the Annals of Surgical Oncology.1 In this article we validated the use of the breast cancer nomogram to predict nonsentinel lymph node (non-SLN) positivity developed by Van Zee et al.2 In addition, our study validated the use of touch-imprint cytology (TIC) in lieu of frozen section (FS) as a nomogram variable. Our study evaluated 200 patients, including 39 patients for whom information regarding either estrogen receptor (ER) status (n = 4) or lymphovascular invasion (LVI) (n = 35) was unavailable. We acknowledged this issue in the manuscript and noted that whether the ER and/or LVI status was positive or negative would not change the outcome of the validation. (The data were not shown). In addition, our study included 29 patients who received neoadjuvant chemotherapy (NCT). For the subset of patients treated with NCT, the mean predicted percentage risk of non-SLN metastases in each risk group correlated with the observed risk (r = 0.92). In our discussion, we acknowledged that dedicated validation for the use of this nomogram in patients receiving NCT is needed. …