Breast Cancer: Prediction Tools

Our breast cancer nomograms are online prediction tools that can help calculate elements of breast cancer risk for an individual patient. Doctors at Memorial Sloan Kettering Cancer Center have developed three nomograms that can be used to assess different types of cancer risk:

The information these nomograms provide can help physicians and their patients make important decisions about treatment. These tools were designed to be used by physicians. If you are a patient, we recommend that you use these tools only in consultation with your doctor.

The information required to complete each nomogram should be available to a patient’s surgeon. If the patient is newly diagnosed with breast cancer and has not undergone surgery or excisional biopsies, information about tumor size and multifocality based on core biopsies, mammography, ultrasound, or MRI can be used to complete the nomogram, and has been shown to provide a good estimate.

Risk of Sentinel Lymph Node Metastasis

Our sentinel lymph node metastasis nomogram is designed to predict the likelihood that cancer has spread to the sentinel lymph nodes in patients newly diagnosed with breast cancer. This nomogram is not appropriate for patients who have already undergone neoadjuvant therapy. It is also not a substitute for a sentinel lymph node biopsy.

In order for this nomogram to provide an accurate prediction, you will need to include accurate values for all of the information below.

  • Age of patient: May be between 20 and 91.
  • Tumor size: From 0.1 to 11 cm.
  • Special type: Yes or no. Special types include pure tubular, pure colloid (mucinous), or typical medullary carcinomas. Other histologies, such as atypical medullary carcinoma or carcinoma with ductal and lobular features, must be classified as ductal.
  • Tumor location: Either upper inner quadrant (UIQ) or other location within the breast. The nomogram compares UIQ against other quadrants.
  • Lymphovascular invasion: Whether the presence of one or more tumor cells was found in the lymphatic or vascular structure.
  • Multifocality: Whether cells have separated from the main tumor mass.
  • Tumor type and grade: Ductal or lobular. If ductal, the nuclear grade must be specified — I, II, or III.
  • Estrogen receptor status: Positive, negative, or unknown. We define ER positive as at least 10 percent of the cells being positive.
  • Progesterone receptor status: Positive, negative, or unknown.

Risk of Additional Nodal Metastasis

Our additional nodal metastasis nomogram, designed for patients with primary invasive breast cancer that has already spread to the sentinel lymph nodes, can be used to predict whether cancer has spread to other non-sentinel lymph nodes under the arm.

This nomogram is not appropriate for patients who have had systemic therapy (chemotherapy or hormone therapy) either before or after therapy. It is also not appropriate for patients who have received radiation therapy to the side of the body for which this tool is being used. In addition, surgery cannot have been performed on the axilla for which the calculation is being performed. The lymph nodes of this axilla should not be enlarged.

In order for this nomogram to provide an accurate prediction, you will need to include accurate values for all of the information below.

  • Frozen section performed: Yes or no. This need not have been the method that detected cancer in sentinel lymph nodes.
  • Tumor size: From 0.1 to 9 cm.
  • Tumor type and grade: Ductal or lobular. If ductal, the nuclear grade must be specified — I, II, or III.
  • Number of positive sentinel lymph nodes: Value must be between 1 and 7.
  • Method of detection in sentinel lymph nodes: Frozen section, routine histopathology, H&E stains of serial sections, or immunohistochemistry (IHC).
  • Number of negative sentinel lymph nodes: Value must be between 0 and 14.
  • Lymphovascular invasion: Whether the presence of one or more tumor cells was found in the lymphatic or vascular structure.
  • Multifocality: Whether cells have separated from the main tumor mass.
  • Estrogen receptor status: Positive or negative. We define ER positive as at least 10 percent of the cells being positive.

Risk of Ductal Carcinoma In Situ (DCIS) Recurrence

Our ductal carcinoma in situ (DCIS) recurrence nomogram is designed to predict the likelihood that a patient’s breast cancer will recur in the same breast after receiving breast-conserving surgery for ductal carcinoma in situ.

In order for this nomogram to provide an accurate prediction, you will need to include accurate values for all of the information below.

  • Age at diagnosis: May be between 25 and 90.
  • Family history: Whether the patient has first- or second-degree relatives with breast cancer.
  • Presentation: Whether abnormality was detected during physical examination or imaging study.
  • Adjuvant radiation therapy: Whether radiation was given after breast-conserving surgery.
  • Adjuvant endocrine therapy: Whether anti-estrogen treatment (e.g., tamoxifen, raloxifene) was given.
  • Nuclear grade: Low, intermediate, or high.
  • Association of necrosis with DCIS: Yes or no, as described in the pathology report.
  • Surgical margins: Negative, positive, or close.
  • Number of surgical excisions: 1 to 4.
  • Year of surgery: 1991 to the present.

Contact Us

If you have questions or comments, please contact us at nomograms@mskcc.org.

Use our breast cancer nomograms.