Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers

Tiffany Torstenson, Miraj G. Shah-Khan, Tanya L. Hoskin, Marilyn J. Morton, Darcy L. Adamczyk, Katie N. Jones, Jane Case, Stephane Chartier, Judy C Boughey

Research output: Contribution to journalArticle

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Abstract

Background: Memorial Sloan Kettering Cancer Center (MSKCC) and MD Anderson Cancer Center (MDACC) have established nomograms to predict sentinel node positivity. We propose the addition of two novel variables - distance of tumor from the nipple and from the skin - can improve their performance. Methods: Ultrasounds of clinical T1/T2 tumors were reviewed. Distances of the tumor from the skin and from the nipple were measured. MSKCC and MDACC nomogram predictions and the AUC-ROC for each model were calculated. The added utility of the two variables was then examined using multiple logistic regression. Results: Of 401 cancers studied, 79 (19.7 %) were node positive. The mean distance of tumors from the nipple in node-positive patients was 4.9 cm compared with 6.0 cm in node-negative patients (p = 0.0007). The mean distance of tumors from the skin was closer in node-positive cases (0.8 cm) versus node-negative cases (1.0 cm, p = 0.0007). The MSKCC and MDACC nomograms AUC-ROC values were 0.71 (95 % CI 0.64-0.77) and 0.74 (95 % CI 0.68-0.81). When adjusted for the MSKCC predicted probability, addition of both distance from nipple (p = 0.008) and distance from skin (p = 0.02) contributed significantly to prediction of nodal positivity and improved the AUC-ROC to 0.75 (95 % CI 0.70-0.81). Similarly, distance from nipple (p = 0.002), but not distance from skin (p = 0.09), added modestly to the MDACC nomogram performance (AUC 0.77; 95 % CI 0.71-0.83). Conclusions: Distance of tumor from the nipple and from the skin are important variables associated with nodal positivity. Adding these to established nomograms improves prediction of nodal positivity.

Original languageEnglish (US)
Pages (from-to)3286-3293
Number of pages8
JournalAnnals of Surgical Oncology
Volume20
Issue number10
DOIs
StatePublished - Oct 2013

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Breast Neoplasms
Nipples
Neoplasms
Nomograms
Skin
Area Under Curve
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers. / Torstenson, Tiffany; Shah-Khan, Miraj G.; Hoskin, Tanya L.; Morton, Marilyn J.; Adamczyk, Darcy L.; Jones, Katie N.; Case, Jane; Chartier, Stephane; Boughey, Judy C.

In: Annals of Surgical Oncology, Vol. 20, No. 10, 10.2013, p. 3286-3293.

Research output: Contribution to journalArticle

Torstenson, T, Shah-Khan, MG, Hoskin, TL, Morton, MJ, Adamczyk, DL, Jones, KN, Case, J, Chartier, S & Boughey, JC 2013, 'Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers', Annals of Surgical Oncology, vol. 20, no. 10, pp. 3286-3293. https://doi.org/10.1245/s10434-013-3110-7
Torstenson, Tiffany ; Shah-Khan, Miraj G. ; Hoskin, Tanya L. ; Morton, Marilyn J. ; Adamczyk, Darcy L. ; Jones, Katie N. ; Case, Jane ; Chartier, Stephane ; Boughey, Judy C. / Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 10. pp. 3286-3293.
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abstract = "Background: Memorial Sloan Kettering Cancer Center (MSKCC) and MD Anderson Cancer Center (MDACC) have established nomograms to predict sentinel node positivity. We propose the addition of two novel variables - distance of tumor from the nipple and from the skin - can improve their performance. Methods: Ultrasounds of clinical T1/T2 tumors were reviewed. Distances of the tumor from the skin and from the nipple were measured. MSKCC and MDACC nomogram predictions and the AUC-ROC for each model were calculated. The added utility of the two variables was then examined using multiple logistic regression. Results: Of 401 cancers studied, 79 (19.7 {\%}) were node positive. The mean distance of tumors from the nipple in node-positive patients was 4.9 cm compared with 6.0 cm in node-negative patients (p = 0.0007). The mean distance of tumors from the skin was closer in node-positive cases (0.8 cm) versus node-negative cases (1.0 cm, p = 0.0007). The MSKCC and MDACC nomograms AUC-ROC values were 0.71 (95 {\%} CI 0.64-0.77) and 0.74 (95 {\%} CI 0.68-0.81). When adjusted for the MSKCC predicted probability, addition of both distance from nipple (p = 0.008) and distance from skin (p = 0.02) contributed significantly to prediction of nodal positivity and improved the AUC-ROC to 0.75 (95 {\%} CI 0.70-0.81). Similarly, distance from nipple (p = 0.002), but not distance from skin (p = 0.09), added modestly to the MDACC nomogram performance (AUC 0.77; 95 {\%} CI 0.71-0.83). Conclusions: Distance of tumor from the nipple and from the skin are important variables associated with nodal positivity. Adding these to established nomograms improves prediction of nodal positivity.",
author = "Tiffany Torstenson and Shah-Khan, {Miraj G.} and Hoskin, {Tanya L.} and Morton, {Marilyn J.} and Adamczyk, {Darcy L.} and Jones, {Katie N.} and Jane Case and Stephane Chartier and Boughey, {Judy C}",
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T1 - Novel factors to improve prediction of nodal positivity in patients with clinical T1/T2 breast cancers

AU - Torstenson, Tiffany

AU - Shah-Khan, Miraj G.

AU - Hoskin, Tanya L.

AU - Morton, Marilyn J.

AU - Adamczyk, Darcy L.

AU - Jones, Katie N.

AU - Case, Jane

AU - Chartier, Stephane

AU - Boughey, Judy C

PY - 2013/10

Y1 - 2013/10

N2 - Background: Memorial Sloan Kettering Cancer Center (MSKCC) and MD Anderson Cancer Center (MDACC) have established nomograms to predict sentinel node positivity. We propose the addition of two novel variables - distance of tumor from the nipple and from the skin - can improve their performance. Methods: Ultrasounds of clinical T1/T2 tumors were reviewed. Distances of the tumor from the skin and from the nipple were measured. MSKCC and MDACC nomogram predictions and the AUC-ROC for each model were calculated. The added utility of the two variables was then examined using multiple logistic regression. Results: Of 401 cancers studied, 79 (19.7 %) were node positive. The mean distance of tumors from the nipple in node-positive patients was 4.9 cm compared with 6.0 cm in node-negative patients (p = 0.0007). The mean distance of tumors from the skin was closer in node-positive cases (0.8 cm) versus node-negative cases (1.0 cm, p = 0.0007). The MSKCC and MDACC nomograms AUC-ROC values were 0.71 (95 % CI 0.64-0.77) and 0.74 (95 % CI 0.68-0.81). When adjusted for the MSKCC predicted probability, addition of both distance from nipple (p = 0.008) and distance from skin (p = 0.02) contributed significantly to prediction of nodal positivity and improved the AUC-ROC to 0.75 (95 % CI 0.70-0.81). Similarly, distance from nipple (p = 0.002), but not distance from skin (p = 0.09), added modestly to the MDACC nomogram performance (AUC 0.77; 95 % CI 0.71-0.83). Conclusions: Distance of tumor from the nipple and from the skin are important variables associated with nodal positivity. Adding these to established nomograms improves prediction of nodal positivity.

AB - Background: Memorial Sloan Kettering Cancer Center (MSKCC) and MD Anderson Cancer Center (MDACC) have established nomograms to predict sentinel node positivity. We propose the addition of two novel variables - distance of tumor from the nipple and from the skin - can improve their performance. Methods: Ultrasounds of clinical T1/T2 tumors were reviewed. Distances of the tumor from the skin and from the nipple were measured. MSKCC and MDACC nomogram predictions and the AUC-ROC for each model were calculated. The added utility of the two variables was then examined using multiple logistic regression. Results: Of 401 cancers studied, 79 (19.7 %) were node positive. The mean distance of tumors from the nipple in node-positive patients was 4.9 cm compared with 6.0 cm in node-negative patients (p = 0.0007). The mean distance of tumors from the skin was closer in node-positive cases (0.8 cm) versus node-negative cases (1.0 cm, p = 0.0007). The MSKCC and MDACC nomograms AUC-ROC values were 0.71 (95 % CI 0.64-0.77) and 0.74 (95 % CI 0.68-0.81). When adjusted for the MSKCC predicted probability, addition of both distance from nipple (p = 0.008) and distance from skin (p = 0.02) contributed significantly to prediction of nodal positivity and improved the AUC-ROC to 0.75 (95 % CI 0.70-0.81). Similarly, distance from nipple (p = 0.002), but not distance from skin (p = 0.09), added modestly to the MDACC nomogram performance (AUC 0.77; 95 % CI 0.71-0.83). Conclusions: Distance of tumor from the nipple and from the skin are important variables associated with nodal positivity. Adding these to established nomograms improves prediction of nodal positivity.

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