TY - JOUR
T1 - The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the “Hôpital Tenon” score revisited. A two-institution study
AU - Barco, I.
AU - García-Fernández, A.
AU - Chabrera, C.
AU - Fraile, M.
AU - Vallejo, E.
AU - Lain, J. M.
AU - Deu, J.
AU - González, S.
AU - González, C.
AU - Veloso, E.
AU - Torres, J.
AU - Torras, M.
AU - Cirera, L.
AU - Pessarrodona, A.
AU - Giménez, N.
AU - García-Font, M.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - © 2016, Federación de Sociedades Españolas de Oncología (FESEO). Introduction: Until recently, completion ALND has been considered the standard of care after a positive SN in breast cancer patients. However, most patients will not display further axillary involvement. The Tenon score is a simple nomogram that can be used intraoperatively to avoid completion ALND in low-risk patients. We aimed at validating the Tenon score on a SN-positive patient sample that had been preoperatively selected using axillary US examination. Patients and method: We used a retrospective analysis of our bicentric database that included 246 breast cancer patients with a positive SN. We calculated sensitivity, specificity, as well as positive and negative predictive values for each cut-off point. ROCs were constructed and corresponding AUC values were calculated as a measure of discriminative capacity. Results: At least one non-SN was positive in 52 patients (21.1 %). 118 patients (48 %) had a score up to 5. Among them, three had at least one positive non-SN. NPV was 97.5 %. Using that threshold, the ROCs analysis showed an AUC of 0.822 (95 % CI 0.764–0.880). Conclusion: Use of preoperative axillary US examination led to a modification of the proposed Tenon cut-off value from 3.5 to 5 to attain good predictive power for non-SN status. Straightforward intraoperative use of the Tenon score may be considered an advantage over other available nomograms.
AB - © 2016, Federación de Sociedades Españolas de Oncología (FESEO). Introduction: Until recently, completion ALND has been considered the standard of care after a positive SN in breast cancer patients. However, most patients will not display further axillary involvement. The Tenon score is a simple nomogram that can be used intraoperatively to avoid completion ALND in low-risk patients. We aimed at validating the Tenon score on a SN-positive patient sample that had been preoperatively selected using axillary US examination. Patients and method: We used a retrospective analysis of our bicentric database that included 246 breast cancer patients with a positive SN. We calculated sensitivity, specificity, as well as positive and negative predictive values for each cut-off point. ROCs were constructed and corresponding AUC values were calculated as a measure of discriminative capacity. Results: At least one non-SN was positive in 52 patients (21.1 %). 118 patients (48 %) had a score up to 5. Among them, three had at least one positive non-SN. NPV was 97.5 %. Using that threshold, the ROCs analysis showed an AUC of 0.822 (95 % CI 0.764–0.880). Conclusion: Use of preoperative axillary US examination led to a modification of the proposed Tenon cut-off value from 3.5 to 5 to attain good predictive power for non-SN status. Straightforward intraoperative use of the Tenon score may be considered an advantage over other available nomograms.
KW - Breast neoplasms
KW - Non-sentinel lymph node metastasis
KW - Prognosis
KW - Scoring system
KW - Sentinel lymph node biopsy
U2 - https://doi.org/10.1007/s12094-016-1487-z
DO - https://doi.org/10.1007/s12094-016-1487-z
M3 - Article
VL - 18
SP - 1098
EP - 1105
ER -