The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the “Hôpital Tenon” score revisited. A two-institution study

• Published in: Clinical & translational oncology 2016-11, Vol.18 (11), p.1098-1105
• Main Authors: Barco, I., García-Fernández, A., Chabrera, C., Fraile, M., Vallejo, E., Lain, J. M., Deu, J., González, S., González, C., Veloso, E., Torres, J., Torras, M., Cirera, L., Pessarrodona, A., Giménez, N., García-Font, M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Axilla; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Female; Humans; Lymph Node Excision - methods; Lymphatic Metastasis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging - methods; Nomograms; Oncology; Research Article; Retrospective Studies; Sentinel Lymph Node Biopsy
• ISSN: 1699-048X; 1699-3055
• DOI: 10.1007/s12094-016-1487-z

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.