Authors: Isabel T Rubio Martin EspinosaBravo Maxi Rodrigo Maria Amparo Viguri Diaz David Hardisson Amaia Sagasta Basilio Dueñas Vicente Peg
Publish Date: 2014/08/28
Volume: 147, Issue: 2, Pages: 371-380
Abstract
Several models have been developed to predict nonsentinel nodes NSLN metastasis in patients with a positive sentinel node SLN that incorporates a standard pathology examination of the SLN It has been reported that total tumoral load TTL in the SLNs assessed by onestep nucleic acid amplification OSNA is a predictive factor for additional NSLN metastasis in the axillary lymph node dissection ALND The objective was to develop a nomogram that predicts patient´s risk of additional NSLN metastasis incorporating TTL in the SLNs assessed by OSNA Six hundred and ninetyseven consecutive patients with positive SLN evaluation by OSNA and a completion ALND were recruited Pathologic features of the primary tumor and SLN metastases including TTL were collected Multivariate logistic regression identified factors predictive of nonSLN metastasis A nomogram was developed with these variables and validated in an external cohort On multivariate logistic regression analysis tumor size number of affected SLN Her2 overexpression lymphovascular invasion and TTL were each associated with the likelihood of additional NSLN metastasis p 005 The overall predictive accuracy of the nomogram as measured by the AUC was 07552 95 CI 07159–07945 When applied to the external cohort the nomogram was accurate with an AUC = 0678 95 CI 0621–0736 This novel nomogram that incorporates TTL assessed by OSNA performs well and may help clinicians to make decisions about ALND for individual patients Moreover the standardization of pathologic assessment by OSNA may help to achieve interinstitutional reproducibility among nomogramsParticipating investigators collected data Paz Santiago MD Hospital de A Coruña La Coruña Spain Sofia Pereira MD Hospital Virgen de la Macarena Sevilla Spain Octavio Burgues MD Hospital Clinico de Valencia Valencia Spain Angeles Torres MD Hospital Universitario Rio Hortega Valladolid Spain Irune Ruiz MD HU Donostia San Sebastian Spain
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