Supporting Publications Visit PubMed to view the journal articles that support these nomograms 
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Additional Nodal Metastasis Nomogram
This tool applies to patients with primary invasive breast cancer that has already spread to the sentinel lymph nodes. The patient should not have had systemic therapy (chemotherapy drugs or hormones), including neoadjuvant therapy, and must not have received radiation therapy to the side of the body for which this tool is being used. 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.
Our recommendation is that these tools be used by physicians. Patients should use these tools only in consultation with their physicians.
What Information Will You Need?
| Information Needed |
Parameters/Further Explanation |
Needed For |
| Pathologic size of the tumor (breast tumor size) |
Defined in centimeters -- between 0.001 and 9 cm for Additional Nodal Metastasis nomogram; between 0.1 and 11.0 for Sentinel Lymph Nodes Metastasis nomogram |
Both nomograms |
| Tumor type: Ductal or lobular |
If ductal, the nuclear grade must be specified -- I, II, or III |
Both nomograms |
| Lymphovascular invasion |
Whether the presence of one or more tumor cells was found in the lymphatic or vascular structure |
Both nomograms |
| Multifocal |
Whether cells have separated from the main tumor mass |
Both nomograms |
| Estrogen-receptor status |
Positive or negative. (We define ER positive as at least 10 percent of the cells being positive.) Within the Sentinel Lymph Nodes Metastasis Nomogram, an "unknown" status can be indicated |
Both nomograms |
| Was a frozen section performed? |
Need not have been the method that detected cancer in sentinel lymph nodes |
Additional Nodal Metastasis |
| Detected method for in the sentinel lymph nodes? |
-Frozen section
-Routine histopathology
-H&E stains of serial sections
-IHC (immunohistochemistry) |
Additional Nodal Metastasis |
| Number of positive sentinel lymph nodes |
Value must be between 1 and 7 |
Additional Nodal Metastasis |
| Number of negative sentinel lymph nodes |
Value must be between 0 and 14 |
Additional Nodal Metastasis |
| Age of patient |
Age in years between 20 and 91 |
Sentinel Lymph Nodes Metastasis |
| Tumor location |
Either upper inner quadrant (UIQ) or other location within the breast -- the nomogram compares UIQ vs. other quadrants |
Sentinel Lymph Nodes Metastasis |
| Special type |
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 |
Sentinel Lymph Nodes Metastasis |
| Progesterone-receptor status |
Positive, negative, or unknown |
Sentinel Lymph Nodes Metastasis |
Note: The information required should be available to the patient's surgeon. For newly diagnosed patients who have not had surgery or excisional biopsies it has been demonstrated that evaluation of tumor size and multifocality based on core biopsies, mammography, ultrasound, or magnetic resonance imaging provide a good estimate.
How to Access the Prediction Tools
To use the online versions of these prediction tools, click on the Calculate box above.
The Additional Nodal Metastasis Nomogram is also available as Pocket PC, Palm (including Treo 600), or Macromedia Flash software. To download this software submit your e-mail address.
