A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making

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• 作者：Rick G. Pleijhuis ; Annemiek B.G. Kwast ; Liesbeth Jansen ; Jakob de Vries ; Rosanne Lanting ; Joost Bart ; Theo Wiggers ; Gooitzen M. van Dam ; Sabine Siesling
• 关键词：Breast-conserving surgery ; Surgical margin status ; Nomogram ; Breast cancer
• 刊名：The Breast
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：22
• 期：5
• 页码：773-779
• 全文大小：556 K

文摘

Background

Breast-conserving therapy, consisting of lumpectomy and adjuvant radiotherapy, is considered standard treatment for early-stage breast cancer. One of the most important risk factors of local recurrence is the presence of positive surgical margins following lumpectomy. We aimed to develop and validate a predictive model (nomogram) to predict for positive margins following the first attempt at lumpectomy as a preoperative tool for clinical decision-making.

Methods

Patients with clinical T_1-2N_0-1M_x-0 histology-proven invasive breast carcinoma who underwent BCT throughout the North-East region of The Netherlands between June 2008 and July 2009 were selected from the Netherlands Cancer Registry (n?=?1185). Results from multivariate logistic regression analyses served as the basis for development of the nomogram. Nomogram calibration and discrimination were assessed graphically and by calculation of a concordance index, respectively. Nomogram performance was validated on an external independent dataset (n?=?331) from the University Medical Center Groningen.

Results

The final multivariate regression model included clinical, radiological, and pathological variables. Concordance indices were calculated of 0.70 (95 % CI: 0.66-0.74) and 0.69 (95 % CI: 0.63-0.76) for the modeling and the validation group, respectively. Calibration of the model was considered adequate in both groups. A nomogram was developed as a graphical representation of the model. Moreover, a web-based application () was build to facilitate the use of our nomogram in a clinical setting.

Conclusion

We developed and validated a nomogram that enables estimation of the preoperative risk of positive margins in breast-conserving surgery. Our nomogram provides a valuable tool for identifying high-risk patients who might benefit from preoperative MRI and/or oncoplastic surgery.