Nomogram for Non-Sentinel Node Metastasis in Breast Cancer Cases

Axillary lymph node dissection (ALND), which has long been used to evaluate the status of the axillary nodes, is known to be associated with a high morbidity rate (Kell et al., 2010). Sentinel lymph node biopsy (SLNB) has successfully replaced ALND for evaluation of the axilla in breast cancer patients with clinically negative axilla (Kell et al., 2010). However, ALND performed in SLNBpositive patients demonstrated the absence of metastasis in 22-71% of the non-SLNs (Zhu et al., 2013). To avoid performing ALND for non-SLN-negative patients with SLN-positive axilla, nomograms and scoring systems for predicting the status of the axillary non-SLNs have been developed in many centers (Van Zee et al., 2003; Degnim et al., 2005; Smidt et al., 2005; Chapgar et al., 2006; Pal et al., 2008; Alran et al., 2007; Kohrt et al., 2008; Cho et al., 2008; Coufal et al., 2009; Coutant et al., 2009; Gur et al., 2010; Perhavec et al., 2010; Lombardi, et al., 2011; Mittendorf et al., 2012; Meretoja et al., 2012; Derici et al., 2012). Many studies have tested these models and have obtained varying results (Van Zee et al., 2003; Kocsis et al., 2004; Degnim et al., 2005; Soni et al.,