恶性黑色素瘤存在四种经过外部验证的前哨淋巴结活检 (SNB) 预测列线图，每种都包含不同的临床和组织病理学变量，这可能导致同一患者的风险估计存在显着差异。我们通过使用假设的黑色素瘤病例来证明这种变异性。我们比较了 MSKCC 和 MIA 计算器。使用随机数生成器，创建了 300 名假设的薄黑色素瘤“患者”，这些患者的年龄、肿瘤厚度、Clark 水平、身体位置、溃疡、黑色素瘤亚型、有丝分裂和淋巴管侵犯 (LVI) 各不相同。卡方检验用于检测列线图之间风险估计的统计显着差异。在预测偏差 > 10% 的情况下，使用多元线性回归来确定最相关的病理特征。在 300 个随机生成的病例中，有 164 个因临床情况不太可能而被删除。 MSKCC 列线图通常计算出的风险低于 MIA (p < 0.001)。使用 MSKCC 计算器，任何“患者”获得的最高风险评分为 136 名患者中的 1 名 (0.7%)，而使用 MIA 列线图，136 名患者中的 58 名 (43%，p < 0.001) 预测风险 >15 %。对列线图之间差异 >10% 的患者进行回归分析显示，LVI (26，p < 0.001)、有丝分裂 (14，p < 0.001) 和黑色素瘤亚型 (8，p < 0.001) 是 MIA 中系数较高的因素， MSKCC 中不存在。列线图在预测 SNB 风险时是有用的工具，但提供的风险输出对所包含的预测因素非常敏感。© 2024。外科肿瘤学会。

Four externally validated sentinel node biopsy (SNB) prediction nomograms exist for malignant melanoma that each incorporate different clinical and histopathologic variables, which can result in substantially different risk estimations for the same patient. We demonstrate this variability by using hypothetical melanoma cases.We compared the MSKCC and MIA calculators. Using a random number generator, 300 hypothetical thin melanoma "patients" were created with varying age, tumor thickness, Clark level, location on the body, ulceration, melanoma subtype, mitosis, and lymphovascular invasion (LVI). The chi-square test was used to detect statistically significant differences in risk estimations between nomograms. Multivariate linear regression was used to determine the most relevant contributing pathologic features in cases where the predictions diverged by > 10%.Of 300 randomly generated cases, 164 were deleted as their clinical scenarios were unlikely. The MSKCC nomogram generally calculated a lower risk than the MIA (p < 0.001). The highest risk score attained for any "patient" using MSKCC calculator was 15% achieved in one of 136 patients (0.7%), whereas using the MIA nomogram, 58 of 136 patients (43%, p < 0.001) had predicted risk >15%. Regression analysis on patients with >10% difference between nomograms revealed LVI (26, p < 0.001), mitosis (14, p < 0.001), and melanoma subtype (8, p < 0.001) were the factors with high coefficients within MIA that were not present in MSKCC.Nomograms are useful tools when predicting SNB risk but provide risk outputs that are quite sensitive to included predictors.© 2024. Society of Surgical Oncology.