Resumen de The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the “Hôpital Tenon” score revisited: A two-institution study
Israel Barco Nebreda, Antonio García Fernández, Carolina Chabrera Sanz, Manuel Fraile, E. Vallejo, Josep Maria Laín Llach, J. Deu, S. González, C. González, Enrique Veloso, J. Torres, M. Torras, Lluís Cirera Nogueras, A. Pessarrodona, Nuria Giménez Gómez, Marc García Font
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.
