title: The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the "Hôpital Tenon" score revisited. A two-institution study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Barco
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain. agarcia@mutuaterrassa.es.
authors.forename: A
authors.initials: A
authors.lastname: García-Fernández
authors.affiliation: Department of Nursing, School of Health Science, TecnoCampus Mataró-Maresme, Mataró, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Chabrera
authors.affiliation: Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fraile
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vallejo
authors.affiliation: Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Lain
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Deu
authors.affiliation: Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: González
authors.affiliation: Breast Unit, Department of Pathology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: González
authors.affiliation: Breast Unit, Department of Surgery, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Veloso
authors.affiliation: Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Torres
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Torras
authors.affiliation: Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Cirera
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pessarrodona
authors.affiliation: University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.|Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Giménez
authors.affiliation: University International of Catalunya, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: García-Font
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049451:Nomograms; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
keywords: Breast neoplasms; Non-sentinel lymph node metastasis; Prognosis; Scoring system; Sentinel lymph node biopsy