Validation and update of a lymph node metastasis prediction model for breast cancer

Si Qi Qiu, Merel Aarnink, Marissa C. van Maaren, Monique D. Dorrius, Arkajyoti Bhattacharya, Jeroen Veltman, Caroline A.H. Klazen, Jan H. Korte, Susanne H. Estourgie, Pieter Ott, Wendy Kelder, Huan Cheng Zeng, Hendrik Koffijberg, Guo Jun Zhang, Gooitzen M. Van Dam, Sabine Siesling* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)700-707
Number of pages8
JournalEuropean journal of surgical oncology
Issue number5
Publication statusPublished - May 2018


  • Axillary lymph node metastasis
  • Axillary surgery omission
  • Breast cancer
  • Model
  • Prediction model


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