A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making
| Autor: | A.B.G. Kwast, Liesbeth Jansen, Gooitzen M. van Dam, Jakob de Vries, Rosanne Lanting, Sabine Siesling, Joost Bart, Rick G. Pleijhuis, Theo Wiggers |
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| Přispěvatelé: | Microbes in Health and Disease (MHD), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Targeted Gynaecologic Oncology (TARGON), Faculty of Behavioural, Management and Social Sciences |
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Neoplasm
Residual medicine.medical_treatment Mastectomy Segmental THERAPY Nomogram Breast cancer TUMOR Breast-conserving surgery RISK Standard treatment Lumpectomy Calcinosis General Medicine Middle Aged CONSERVATION SURGERY Magnetic Resonance Imaging CARCINOMA IN-SITU Preoperative Period Female Radiology Surgical margin status Mastectomy Adult medicine.medical_specialty Concordance Breast Neoplasms LOCAL RECURRENCE INVASIVE CANCER Decision Support Techniques MASTECTOMY medicine Humans Aged Neoplasm Staging Internet business.industry Carcinoma medicine.disease Surgery Oncoplastic Surgery Nomograms CORE NEEDLE-BIOPSY Radiotherapy Adjuvant Neoplasm Grading Neoplasm Recurrence Local business NODE |
| Zdroj: | The Breast, 22(5), 773-779. Churchill Livingstone |
| ISSN: | 1532-3080 0960-9776 |
| DOI: | 10.1016/j.breast.2013.01.010 |
| Popis: | 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 T1-2N0-1Mx-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 (http://www.breastconservation.com) 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. |
| Databáze: | OpenAIRE |
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