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Population-Based Va...
Population-Based Validation of the MIA and MSKCC Tools for Predicting Sentinel Lymph Node Status
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- Bagge, Roger Olofsson (författare)
- Gothenburg University,Göteborgs universitet,University of Gothenburg,Sahlgrenska Academy,Sahlgrenska University Hospital,Sahlgrenska Centrum för Cancerforskning (SCCR),Wallenberg Centre for Molecular and Translational Medicine,Sahlgrenska Center for Cancer Research (SCCR)
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- Mikiver, Rasmus (författare)
- Linköping University,Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Regionalt cancercentrum
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- Marchetti, Michael A. (författare)
- Skagit Reg Hlth, WA USA
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- Lo, Serigne N. (författare)
- Univ Sydney, Australia; Univ Sydney, Australia,University of Sydney
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- van Akkooi, Alexander C. J. (författare)
- Univ Sydney, Australia; Univ Sydney, Australia,University of Sydney
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- Coit, Daniel G. (författare)
- Mem Sloan Kettering Canc Ctr, NY USA,Memorial Sloan-Kettering Cancer Center
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- Ingvar, Christian (författare)
- Lund University,Lunds universitet,Kirurgi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lunds Melanomstudiegrupp,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Surgery (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund Melanoma Study Group,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments
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- Isaksson, Karolin (författare)
- Lund University,Lunds universitet,Lunds Melanomstudiegrupp,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Lund Melanoma Study Group,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Central Hospital Kristianstad
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- Scolyer, Richard A. (författare)
- Univ Sydney, Australia; Univ Sydney, Australia; Royal Prince Alfred Hosp, Australia; NSW Hlth Pathol, Australia; Univ Sydney, Australia,University of Sydney,Royal Prince Alfred Hospital
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- Thompson, John F. (författare)
- Univ Sydney, Australia; Univ Sydney, Australia,University of Sydney
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- Varey, Alexander H. R. (författare)
- Univ Sydney, Australia; Univ Sydney, Australia; Westmead Hosp, Australia,University of Sydney,Westmead Hospital
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- Wong, Sandra L. (författare)
- Dartmouth Hitchcock Med Ctr, NH USA,Dartmouth-Hitchcock Medical Center
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- Lyth, Johan (författare)
- Linköping University,Linköpings universitet,Avdelningen för samhälle och hälsa,Medicinska fakulteten,Region Östergötland, Forskningsstrategiska enheten
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- Bartlett, Edmund K. (författare)
- Mem Sloan Kettering Canc Ctr, NY USA,Memorial Sloan-Kettering Cancer Center
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(creator_code:org_t)
- 2024
- 2024
- Engelska.
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Ingår i: JAMA Surgery. - : AMER MEDICAL ASSOC. - 2168-6254 .- 2168-6262.
- Relaterad länk:
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://lup.lub.lu.s...
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https://gup.ub.gu.se...
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Abstract
Ämnesord
Stäng
- Importance Patients with melanoma are selected for sentinel lymph node biopsy (SLNB) based on their risk of a positive SLN. To improve selection, the Memorial Sloan Kettering Cancer Center (MSKCC) and Melanoma Institute Australia (MIA) developed predictive models, but the utility of these models remains to be tested.Objective To determine the clinical utility of the MIA and MSKCC models.Design, Setting, and Participants This was a population-based comparative effectiveness research study including 10 089 consecutive patients with cutaneous melanoma undergoing SLNB from the Swedish Melanoma Registry from January 2007 to December 2021. Data were analyzed from May to August 2023.Main Outcomes and Measures, The predicted probability of SLN positivity was calculated using the MSKCC model and a limited MIA model (using mitotic rate as absent/present instead of count/mm(2) and excluding the optional variable lymphovascular invasion) for each patient. The operating characteristics of the models were assessed and compared. The clinical utility of each model was assessed using decision curve analysis and compared with a strategy of performing SLNB on all patients.Results Among 10 089 included patients, the median (IQR) age was 64.0 (52.0-73.0) years, and 5340 (52.9%) were male. The median Breslow thickness was 1.8 mm, and 1802 patients (17.9%) had a positive SLN. Both models were well calibrated across the full range of predicted probabilities and had similar external area under the receiver operating characteristic curves (AUC; MSKCC: 70.8%; 95% CI, 69.5-72.1 and limited MIA: 69.7%; 95% CI, 68.4-71.1). At a risk threshold of 5%, decision curve analysis indicated no added net benefit for either model compared to performing SLNB for all patients. At risk thresholds of 10% or higher, both models added net benefit compared to SLNB for all patients. The greatest benefit was observed in patients with T2 melanomas using a threshold of 10%; in that setting, the use of the nomograms led to a net reduction of 8 avoidable SLNBs per 100 patients for the MSKCC nomogram and 7 per 100 patients for the limited MIA nomogram compared to a strategy of SLNB for all.Conclusions and Relevance This study confirmed the statistical performance of both the MSKCC and limited MIA models in a large, nationally representative data set. However, decision curve analysis demonstrated that using the models only improved selection for SLNB compared to biopsy in all patients when a risk threshold of at least 7% was used, with the greatest benefit seen for T2 melanomas at a threshold of 10%. Care should be taken when using these nomograms to guide selection for SLNB at the lowest thresholds.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
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Bagge, Roger Olo ...
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Mikiver, Rasmus
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Marchetti, Micha ...
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Lo, Serigne N.
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van Akkooi, Alex ...
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Coit, Daniel G.
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Ingvar, Christia ...
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Isaksson, Karoli ...
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Scolyer, Richard ...
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Thompson, John F ...
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Varey, Alexander ...
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Wong, Sandra L.
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Lyth, Johan
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Bartlett, Edmund ...
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- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kirurgi
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Cancer och onkol ...
- Artiklar i publikationen
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JAMA Surgery
- Av lärosätet
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Linköpings universitet
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Lunds universitet
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Göteborgs universitet