EXTERNAL VALIDATION OF THE MSKCC NOMOGRAM FOR PREDICTING SENTINEL NODE STATUS IN EARLY BREAST CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS justin.james@monash.edu

3103-07

EXTERNAL VALIDATION OF THE MSKCC NOMOGRAM FOR PREDICTING SENTINEL NODE STATUS IN EARLY BREAST CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

8

Australia

Oral or Poster

Axillary management in early breast cancer (EBC) is shifting toward de-escalation, with sentinel node biopsy (SNB) increasingly questioned in low-risk patients. The Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram is the most widely used mathematical model for predicting sentinel node status. This systematic review and meta-analysis aimed to evaluate its external validation, methodological quality, and predictive performance.

A comprehensive search of MEDLINE, Embase, and Cochrane Central was conducted through July 2025 to identify external validation studies of the MSKCC nomogram in clinically node-negative EBC patients. Eligible studies reported discrimination metrics such as the area under the ROC curve (AUC). Risk of bias was assessed using PROBAST. Where confidence intervals (CIs) were not provided, they were estimated using the Hanley & McNeil method. A random-effects meta-analysis was performed.

Eight studies were identified, of which seven provided sufficient data for pooled analysis. Six were rated as low risk of bias, and two as moderate risk. The pooled AUC across included studies was 0.73 (95% CI: 0.476–0.984), supporting moderate discriminatory ability. No studies were judged to have high overall risk of bias.

The MSKCC nomogram demonstrates consistent, though moderate, discriminatory performance across external cohorts. In the current era of axillary de-escalation, nomogram-based strategies may support selective omission of SNB in EBC patients, offering a potential pathway toward safe, individualized axillary management.