title: Validation of the Tenon breast cancer score for predicting non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis: a prospective multicenter study.
abstract: BACKGROUND
  Axillary lymph node dissection (ALND) is the standard treatment for patients with sentinel node (SN) metastasis, but most of these patients have negative non-sentinel nodes (non-SN). We have developed a scoring system (the Tenon score) to help identify a subgroup of patients who have a low risk of having non-SN metastases and who may thus forgo ALND. Here we validated the Tenon score in an independent cohort of SN-positive patients.
  
  
  METHODS
  We tested the accuracy of the Tenon score for predicting non-SN status in a prospective multicenter study of 226 SN-positive breast cancer patients. We calculated the false-negative rate, sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). Receiver operating characteristics (ROC) curves were constructed and the areas under the curve (AUC) were calculated as a measure of discriminatory capacity.
  
  
  RESULTS
  At least one non-SN was positive in 63 patients (27.9%). One hundred and twenty (53.1%) of the 226 patients had a Tenon score of 3.5 or less. Among these 120 patients, five had at least one positive non-SN. With a score cut-off of 3.5, the negative predictive value was 95.8% and the false-negative rate was 4.2%. Overall, the Tenon score accurately predicted non-SN status, with an AUC of 0.82 (95% confidence interval, 0.77-0.88).
  
  
  CONCLUSIONS
  In this multicenter study of an independent patient population, the Tenon score was accurate and reproducible for predicting non-SN status in breast cancer patients. The simplicity and reliability of the variables on which the Tenon score is based may be an advantage over other scoring systems.
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France. charles.coutant@tnn.aphp.fr
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Eric
authors.initials: E
authors.lastname: Fondrinier
authors.forename: Frederic
authors.initials: F
authors.lastname: Marchal
authors.forename: François
authors.initials: F
authors.lastname: Guillemin
authors.forename: Nathalie
authors.initials: N
authors.lastname: Seince
authors.forename: Anabella
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Emile
authors.initials: E
authors.lastname: Darai
authors.forename: Serge
authors.initials: S
authors.lastname: Uzan
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D021701:Sentinel Lymph Node Biopsy; D012720:Severity of Illness Index