{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T08:43:46Z","timestamp":1744533826336},"reference-count":8,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2014,8,29]],"date-time":"2014-08-29T00:00:00Z","timestamp":1409270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2014,8,29]],"date-time":"2014-08-29T00:00:00Z","timestamp":1409270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In settings with limited resources, sentinel lymph node biopsy (SNB) is only offered to breast cancer patients with small tumors and a low a priori risk of axillary metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We investigated whether CancerMath, a free online prediction tool for axillary lymph node involvement, is able to identify women at low risk of axillary lymph node metastases in Malaysian women with 3\u20135\u00a0cm tumors, with the aim to offer SNB in a targeted, cost\u2010effective way.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women with non\u2010metastatic breast cancers, measuring 3\u20135\u00a0cm were identified within the University Malaya Medical Centre (UMMC) breast cancer registry. We compared CancerMath\u2010predicted probabilities of lymph node involvement between women with versus without lymph node metastases. The discriminative performance of CancerMath was tested using receiver operating characteristic (ROC) analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 1,017 patients, 520 (51 %) had axillary involvement. Tumors of women with axillary involvement were more often estrogen\u2010receptor positive, progesterone\u2010receptor positive, and human epidermal growth factor receptor (HER)\u20102 positive. The mean CancerMath score was higher in women with axillary involvement than in those without (53.5 vs. 51.3, <jats:italic>p<\/jats:italic> = 0.001). In terms of discrimination, CancerMath performed poorly, with an area under the ROC curve of 0.553 (95 % confidence interval CI 0.518\u20130.588). Attempts to optimize the CancerMath model by adding ethnicity and HER2 to the model did not improve discriminatory performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For Malaysian women with tumors measuring 3\u20135\u00a0cm, CancerMath is unable to accurately predict lymph node involvement and is therefore not helpful in the identification of women at low risk of node\u2010positive disease who could benefit from SNB.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2752-3","type":"journal-article","created":{"date-parts":[[2014,8,28]],"date-time":"2014-08-28T09:53:06Z","timestamp":1409219586000},"page":"3133-3137","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prediction of Lymph Node Involvement in Patients with Breast Tumors Measuring 3\u20135\u00a0cm in a Middle\u2010Income Setting: the Role of CancerMath"],"prefix":"10.1002","volume":"38","author":[{"given":"E. N.","family":"Pijnappel","sequence":"first","affiliation":[{"name":"Imaging Division University Medical Center Utrecht Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Bhoo\u2010Pathy","sequence":"additional","affiliation":[{"name":"Julius Center, Department of Social and Preventive Medicine, Faculty of Medicine University of Malaya Lembah Pantai 50603 Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Suniza","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. H.","family":"See","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. H.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. H.","family":"Yip","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Hartman","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. A.","family":"Taib","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. M.","family":"Verkooijen","sequence":"additional","affiliation":[{"name":"Imaging Division University Medical Center Utrecht Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,8,29]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2011.01.011"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90"},{"key":"e_1_2_5_4_2","first-page":"827","article-title":"Improved web\u2010based calculators for predicting breast carcinoma outcomes","volume":"128","author":"Michaelson J","year":"2011","journal-title":"Epidemiology"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2011.01.015"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2012.01.034"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr070105"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0030995"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.27527"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-014-2752-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-014-2752-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-014-2752-3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T18:39:44Z","timestamp":1703615984000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-014-2752-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,8,29]]},"references-count":8,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2014,12]]}},"alternative-id":["10.1007\/s00268-014-2752-3"],"URL":"https:\/\/doi.org\/10.1007\/s00268-014-2752-3","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"type":"print","value":"0364-2313"},{"type":"electronic","value":"1432-2323"}],"subject":[],"published":{"date-parts":[[2014,8,29]]}}}