Non sentinel node involvement prediction for sentinel node micrometastases in breast cancer: nomogram validation and comparison with other models.
OBJECTIVE
The risk of non sentinel node (NSN) involvement varies in function of the characteristics of sentinel nodes (SN) and primary tumor. Our aim was to determine and validate a statistical tool (a nomogram) able to predict the risk of NSN involvement in case of SN micro or sub-micrometastasis of breast cancer. We have compared this monogram with other models described in the literature.


METHODS
We have collected data on 905 patients, then 484 other patients, to build and validate the nomogram and compare it with other published scores and nomograms.


RESULTS
Multivariate analysis conducted on the data of the first cohort allowed us to define a nomogram based on 5 criteria: the method of SN detection (immunohistochemistry or by standard coloration with HES); the ratio of positive SN out of total removed SN; the pathologic size of the tumor; the histological type; and the presence (or not) of lympho-vascular invasion. The nomogram developed here is the only one dedicated to micrometastasis and developed on the basis of two large cohorts. The results of this statistical tool in the calculation of the risk of NSN involvement is similar to those of the MSKCC (the similarly more effective nomogram according to the literature), with a lower rate of false negatives.


CONCLUSIONS
this nomogram is dedicated specifically to cases of SN involvement by metastasis lower or equal to 2 mm. It could be used in clinical practice in the way to omit ALND when the risk of NSN involvement is low.
Institut Paoli Calmettes, Marseille, France. houvenaeghelg@marseille.fnclcc.fr
Gilles
G
Houvenaeghel
Marie
M
Bannier
Claude
C
Nos
Sylvia
S
Giard
Herve
H
Mignotte
Jocelyne
J
Jacquemier
Marc
M
Martino
Benjamin
B
Esterni
Catherine
C
Belichard
Jean-Marc
JM
Classe
Christine
C
Tunon de Lara
Monique
M
Cohen
Raoul
R
Payan
Jerome
J
Blanchot
Philippe
P
Rouanet
Frederique
F
Penault-Llorca
Pascal
P
Bonnier
Sandrine
S
Fournet
Aubert
A
Agostini
Frederique
F
Marchal
Jean-Remi
JR
Garbay
D001943:Breast Neoplasms / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015999:Multivariate Analysis; D061206:Neoplasm Micrometastasis / Q000175:diagnosis*; D049451:Nomograms; D015203:Reproducibility of Results; D012306:Risk; D021701:Sentinel Lymph Node Biopsy