ArticleInquiry : a journal of medical care organization, provision and financing
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.
Article in Inquiry : a journal of medical care organization, provision and financing. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Corrections and comments
- Erratum issued
Authors and funding
3 authors.
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No grant is acknowledged in the PubMed record.
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 (
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