Ponzone Riccardo, Maggiorotto Furio, Mariani Luca, Jacomuzzi Maria Elena, Magistris Alessandra, Mininanni Paola, Biglia Nicoletta, Sismondi Piero
Academic Division of Gynecological Oncology, Institute for Cancer Research and Treatment of Candiolo, Strada Provinciale 142, 10060 Candiolo, Turin, Italy.
Am J Surg. 2007 Jun;193(6):686-92. doi: 10.1016/j.amjsurg.2006.09.031.
It is debated whether all patients with a positive sentinel node dissection (SLND) should be submitted to axillary lymph node dissection (ALND). Models have been developed to estimate the likelihood of nonsentinel node (non-SLN) metastases.
The accuracy of the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and MD Anderson scoring system for the prediction of non-SLN status was tested in a consecutive series of 186 SLN-positive breast cancer patients. A multivariate analysis was performed to assess which parameters independently predicted the presence of non-SLN metastases.
The predictive accuracy of the MSKCC nomogram measured by the receiver operating characteristic curve was 0.71, and it was best in patients with <10% risk of non-SLN metastases (sensitivity 100% and specificity 96%). The MD Anderson score predicted non-SLN involvement with low accuracy because it classified 85% of the patients in the intermediate-risk groups. Only SLN macrometastases and tumor multifocality independently predicted non-SLNs involvement.
The MSKCC nomogram can help individualize the surgical treatment of SLN-positive breast cancer when the likelihood of further axillary involvement is low or surgical risks are higher.
对于所有前哨淋巴结清扫（SLND）阳性的患者是否均应接受腋窝淋巴结清扫（ALND）仍存在争议。已开发出模型来估计非前哨淋巴结（非SLN）转移的可能性。
在连续的186例SLN阳性乳腺癌患者中，测试了纪念斯隆凯特琳癌症中心（MSKCC）列线图和MD安德森评分系统预测非SLN状态的准确性。进行多变量分析以评估哪些参数可独立预测非SLN转移的存在。
通过受试者工作特征曲线测量，MSKCC列线图的预测准确性为0.71，在非SLN转移风险<10%的患者中最佳（敏感性100%，特异性96%）。MD安德森评分预测非SLN受累的准确性较低，因为它将85%的患者归类为中风险组。只有SLN大转移灶和肿瘤多灶性可独立预测非SLN受累。
当进一步腋窝受累的可能性较低或手术风险较高时，MSKCC列线图有助于个体化治疗SLN阳性乳腺癌。
