Of note, two of the five variables (LVI and Ki-67) used by these authors to predict RS were not included in our nomogram: LVI is not conducted as routine on every specimen in the setting of node negative ER+/HER2− cancers in our center due to the limited premise in best practice guidelines for using the biomarker to guide adjuvant therapeutic treatment decisions in early-stage breast cancer [40,43,44,45,46]. This evidence concerns the gene ESR1 and cancer.