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Nomograms for Predicting Metastases in Breast Cancer Patient with Positive Sentinel Lymph Node: With Frozen Section

Purpose: To evaluate a breast cancer patient with a positive sentinel lymph node using one of the nomograms of Van Zee et al.

Description

Van Zee et al developed two nomograms for evaluating breast cancer patients undergoing sentinel lymph node biopsy. One nomogram is used when frozen sections are performed as part of the sentinel node protocol. The authors are Memorial Sloan Ketterin Cancer Center in New York City.


Patient selection: breast cancer with at least 1 metastasis in a sentinel lymph node

 

Outcome: additional lymph nodes with metastatic cancer

 

Parameters:

(1) nuclear grade

(2) lymphovascular invasion (LVI)

(3) multifocal primary tumor

(4) estrogen receptor status

(5) number of negative sentinel lymph nodes (from 0 to 14)

(6) number of positive sentinel lymph nodes (from 1 to 7)

(7) size of primary tumor in cm (from 0 to 9 cm)

(8) method of detection

 

points for positive sentinel lymph node =

= (15.98 * (number)) - 15.95

 

points for pathology size =

= 11.11 * (size in cm)

 

Parameter

Finding

Points

nuclear grade

I

0

 

II

1

 

III

10

 

lobular

6.5

LVI

absent

0

 

present

22

multifocal

no (single focus)

0

 

yes

16

ER status

negative

0

 

positive

17.2

number of negative sentinel lymph nodes

14

0

 

13

3

 

12

6

 

11

9.2

 

10

12.6

 

9

16

 

8

19.6

 

7

23.5

 

6

27.6

 

5

32

 

4

37

 

3

42.7

 

2

49.4

 

1

58.2

 

0

79.6

method of detection

immunohistochemistry

0

 

serial section H&E

23

 

routine

36.4

 

frozen section

81

 

total score =

= SUM(points for all 8 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 422 (nomogram indicates highest score 320)

• The higher the score the greater the chances of additional metastases in nonsentinel lymph nodes.

 

Total Score

Percent with Metastases in Nonsentinel Lymph Nodes

< 55

< 2%

55 to 176

(0.002001 * ((score)^2)) - (0.2345 * (score)) + 9.019

176 to 242

(0.6097 * (score)) - 77.42

242 to 306

(-0.002846 * ((score)^2)) + (1.905 * (score)) - 224.5

> 306

> 92%

 

Performance:

• The area under the ROC curve was 0.77.


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Specialty

Objective

ICD-10