Volume 22, Issue 5, Pages 773-779 (October 2013) A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making  Rick G. Pleijhuis, Annemiek B.G. Kwast, Liesbeth Jansen, Jakob de Vries, Rosanne Lanting, Joost Bart, Theo Wiggers, Gooitzen M. van Dam, Sabine Siesling  The Breast  Volume 22, Issue 5, Pages 773-779 (October 2013) DOI: 10.1016/j.breast.2013.01.010 Copyright © 2013 Elsevier Ltd Terms and Conditions

Fig. 1 Discrimination of the final model for the modeling and validation group. The area under the receiver-operating characteristic (AUROC) curve, comparable to the concordance index, indicates the discriminative power of the model. The reference line indicates an AUROC value of 0.5, for which the probability of positive surgical margins is equal to the toss of a coin. An AUROC value of 1.0 would resemble perfect discrimination. The Breast 2013 22, 773-779DOI: (10.1016/j.breast.2013.01.010) Copyright © 2013 Elsevier Ltd Terms and Conditions

Fig. 2 Calibration of the final model in the modeling and validation group. All patients were grouped into deciles (blue triangles and orange dots) based on their predicted probabilities. Mean predicted probabilities were plotted against the actual incidence of positive margins for each decile. Moreover, 95% confidence intervals are shown for both groups. The reference line represents perfect equality of observed frequencies and predicted probabilities. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.) The Breast 2013 22, 773-779DOI: (10.1016/j.breast.2013.01.010) Copyright © 2013 Elsevier Ltd Terms and Conditions

Fig. 3 Nomogram including clinical, radiological, and pathological variables for predicting positive surgical margins following the first attempt at lumpectomy. Instructions for use: Locate the patient's status on the ‘preoperative MRI’ axis. Draw a line straight upward to the ‘points’ axis to determine how many points are assigned to the individual patient. Repeat this process for the axes below. Sum the points achieved for each variable and locate this sum on the ‘total points’ axis. From here, draw a line straight downward to obtain the probability of positive surgical margins following lumpectomy for the individual patient. Note: Due to the relatively high frequency of false negative findings when assessing the presence of co-existing DCIS in a core needle biopsy (CNB), absence of DCIS should be interpreted with caution. We therefore recommend to determine a suitable probability interval by calculating the probability of positive surgical margins for both true and false negative outcomes. A user-friendly web-based version of the nomogram is available at www.breastconservation.com. The Breast 2013 22, 773-779DOI: (10.1016/j.breast.2013.01.010) Copyright © 2013 Elsevier Ltd Terms and Conditions