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Nomograms for Predicting Additional Metastases in Breast Cancer Patient with Positive Sentinel Lymph Node

Purpose: To evaluate a breast cancer patient with a positive sentinel lymph node without frozen section evaluation using a nomogram 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 not 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 =

= (16.66 * (number)) - 16.66

 

points for pathology size =

= 10.37 * (size in cm)

 

Parameter

Finding

Points

nuclear grade

I

0

 

II

5

 

III

16.7

 

lobular

11.7

LVI

absent

0

 

present

20

multifocal

no (single focus)

0

 

yes

17.2

ER status

negative

0

 

positive

12.2

number of negative sentinel lymph nodes

14

0

 

13

2.7

 

12

5.6

 

11

8.7

 

10

11.1

 

9

13.9

 

8

17.2

 

7

21.1

 

6

24.4

 

5

28.7

 

4

33.3

 

3

38.3

 

2

44.4

 

1

52.2

 

0

71.1

method of detection

immunohistochemistry

0

 

serial section H&E

9.1

 

routine

60.9

 

total score =

= SUM(points for all 8 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 362.3 (nomogram indicates highest score 285)

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

 

Total Score

Percent with Metastases in Nonsentinel Lymph Nodes

< 42

< 2%

42 to 156

(0.002249 * ((score)^2)) - (0.2039 * (score)) + 6.709

156 to 201

(0.6667 * (score)) - 74

201 to 277

(-0.003013 * ((score)^2)) + (1.862 * (score)) - 192.6

> 277

> 92%

 


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Specialty

Objective

ICD-10