View in EDS HTML Full Text PDF Full Text

Bridging Global Disparities in Breast Cancer Care: External Validation Study of the MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" and Its Financial Implications of Axillary De-escalation in a Resource Limited Setting

Saved in:
Bibliographic Details
Title: Bridging Global Disparities in Breast Cancer Care: External Validation Study of the MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" and Its Financial Implications of Axillary De-escalation in a Resource Limited Setting
Authors: Raza, Vishal Farid1 vishalraza@hotmail.com, Ehsan, Ayesha1, Khan, Amina Iqbal2
Source: Inquiry (00469580). 8/21/2025, Vol. 62, p1-5. 5p.
Subject Terms: *Retrospective studies, Sentinel lymph node biopsy, Statistical models, Axilla, T-test (Statistics), Breast tumors, Cancer patient medical care, Sentinel lymph nodes, Logistic regression analysis, Probability theory, Descriptive statistics, Chi-squared test, World health, Combined modality therapy, Medical records, Acquisition of data, Health equity, Resource-limited settings, Carcinogenesis, Data analysis software
Geographic Terms: Pakistan
Abstract: Axillary surgery in breast cancer has evolved from radical dissections to selective de-escalations. Identifying patients who may safely omit sentinel lymph node biopsy (SLNB) can further reduce the surgical burden, post operative complications and financial toxicity associated with breast cancer surgical care. The MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" is widely available and free of charge to assess SLNB positivity post neoadjuvant chemotherapy (NACT). This study externally validates its accuracy in a sample of Pakistani women and assesses its implications for cost effective breast cancer care in a resource limited setting. Retrospective chart review of 150 women who underwent axillary sentinel lymph node biopsy post NACT at Shaukat Khanum Memorial Cancer Hospital from January 2023 to August 2024. Predicted node probability and observed positivity on histopathology were recorded. Calibration (Hosmer-Lemeshow test) and discrimination (C-index) were calculated. 98% were ductal carcinomas; tumor sub-types showed luminal A (42.7%), luminal B (4.7%), her2neu (H2N) enriched (14%) and triple negative (TNBC; 38.7%). 18% (n = 27) nodes were positive on final pathology closely aligning with the nomogram's predicted probability of 17.1 ± 10.3%. Calibration showed good model fit (P =.89) while C-index (0.64) indicated moderate discrimination. 12.6% of women would avoid costs of SLNB if omitted in the 0% to 5% bracket and 31.3% of women in the 0% to 10% bracket. TNBC demonstrated lowest positivity of 6.89% (P =.01). The MD Anderson Clinical Calculator for predicting positive sentinel lymph nodes post NACT may have a role in tailoring decisions for axillary de-escalation especially in patients with a low probability score between 0% and 10% with decrease in costs of breast cancer care in LMICs. Future studies incorporating safety of axillary surgery omission using the calculator and its economic impact are warranted. [ABSTRACT FROM AUTHOR]
Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
Text:
  Availability: 1
Header DbId: ehh
DbLabel: Education Research Complete
An: 187508322
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Bridging Global Disparities in Breast Cancer Care: External Validation Study of the MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" and Its Financial Implications of Axillary De-escalation in a Resource Limited Setting
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Raza%2C+Vishal+Farid%22">Raza, Vishal Farid</searchLink><relatesTo>1</relatesTo><i> vishalraza@hotmail.com</i><br /><searchLink fieldCode="AR" term="%22Ehsan%2C+Ayesha%22">Ehsan, Ayesha</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Khan%2C+Amina+Iqbal%22">Khan, Amina Iqbal</searchLink><relatesTo>2</relatesTo>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="JN" term="%22Inquiry+%2800469580%29%22">Inquiry (00469580)</searchLink>. 8/21/2025, Vol. 62, p1-5. 5p.
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: *<searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Sentinel+lymph+node+biopsy%22">Sentinel lymph node biopsy</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+models%22">Statistical models</searchLink><br /><searchLink fieldCode="DE" term="%22Axilla%22">Axilla</searchLink><br /><searchLink fieldCode="DE" term="%22T-test+%28Statistics%29%22">T-test (Statistics)</searchLink><br /><searchLink fieldCode="DE" term="%22Breast+tumors%22">Breast tumors</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer+patient+medical+care%22">Cancer patient medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Sentinel+lymph+nodes%22">Sentinel lymph nodes</searchLink><br /><searchLink fieldCode="DE" term="%22Logistic+regression+analysis%22">Logistic regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Probability+theory%22">Probability theory</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Chi-squared+test%22">Chi-squared test</searchLink><br /><searchLink fieldCode="DE" term="%22World+health%22">World health</searchLink><br /><searchLink fieldCode="DE" term="%22Combined+modality+therapy%22">Combined modality therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+records%22">Medical records</searchLink><br /><searchLink fieldCode="DE" term="%22Acquisition+of+data%22">Acquisition of data</searchLink><br /><searchLink fieldCode="DE" term="%22Health+equity%22">Health equity</searchLink><br /><searchLink fieldCode="DE" term="%22Resource-limited+settings%22">Resource-limited settings</searchLink><br /><searchLink fieldCode="DE" term="%22Carcinogenesis%22">Carcinogenesis</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink>
– Name: SubjectGeographic
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Pakistan%22">Pakistan</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Axillary surgery in breast cancer has evolved from radical dissections to selective de-escalations. Identifying patients who may safely omit sentinel lymph node biopsy (SLNB) can further reduce the surgical burden, post operative complications and financial toxicity associated with breast cancer surgical care. The MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" is widely available and free of charge to assess SLNB positivity post neoadjuvant chemotherapy (NACT). This study externally validates its accuracy in a sample of Pakistani women and assesses its implications for cost effective breast cancer care in a resource limited setting. Retrospective chart review of 150 women who underwent axillary sentinel lymph node biopsy post NACT at Shaukat Khanum Memorial Cancer Hospital from January 2023 to August 2024. Predicted node probability and observed positivity on histopathology were recorded. Calibration (Hosmer-Lemeshow test) and discrimination (C-index) were calculated. 98% were ductal carcinomas; tumor sub-types showed luminal A (42.7%), luminal B (4.7%), her2neu (H2N) enriched (14%) and triple negative (TNBC; 38.7%). 18% (n = 27) nodes were positive on final pathology closely aligning with the nomogram's predicted probability of 17.1 ± 10.3%. Calibration showed good model fit (P =.89) while C-index (0.64) indicated moderate discrimination. 12.6% of women would avoid costs of SLNB if omitted in the 0% to 5% bracket and 31.3% of women in the 0% to 10% bracket. TNBC demonstrated lowest positivity of 6.89% (P =.01). The MD Anderson Clinical Calculator for predicting positive sentinel lymph nodes post NACT may have a role in tailoring decisions for axillary de-escalation especially in patients with a low probability score between 0% and 10% with decrease in costs of breast cancer care in LMICs. Future studies incorporating safety of axillary surgery omission using the calculator and its economic impact are warranted. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=187508322
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/00469580251366150
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 5
        StartPage: 1
    Subjects:
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Sentinel lymph node biopsy
        Type: general
      – SubjectFull: Statistical models
        Type: general
      – SubjectFull: Axilla
        Type: general
      – SubjectFull: T-test (Statistics)
        Type: general
      – SubjectFull: Breast tumors
        Type: general
      – SubjectFull: Cancer patient medical care
        Type: general
      – SubjectFull: Sentinel lymph nodes
        Type: general
      – SubjectFull: Logistic regression analysis
        Type: general
      – SubjectFull: Probability theory
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Chi-squared test
        Type: general
      – SubjectFull: World health
        Type: general
      – SubjectFull: Combined modality therapy
        Type: general
      – SubjectFull: Medical records
        Type: general
      – SubjectFull: Acquisition of data
        Type: general
      – SubjectFull: Health equity
        Type: general
      – SubjectFull: Resource-limited settings
        Type: general
      – SubjectFull: Carcinogenesis
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Pakistan
        Type: general
    Titles:
      – TitleFull: Bridging Global Disparities in Breast Cancer Care: External Validation Study of the MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" and Its Financial Implications of Axillary De-escalation in a Resource Limited Setting
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Raza, Vishal Farid
      – PersonEntity:
          Name:
            NameFull: Ehsan, Ayesha
      – PersonEntity:
          Name:
            NameFull: Khan, Amina Iqbal
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 21
              M: 08
              Text: 8/21/2025
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 00469580
          Numbering:
            – Type: volume
              Value: 62
          Titles:
            – TitleFull: Inquiry (00469580)
              Type: main
ResultId 1