腋窝淋巴结清扫术在哨兵淋巴结微转移浸润病例中的应用：三种预测模型的评估。
Axillary lymph node dissection in the case of sentinel lymph node micrometastatic invasion: evaluation of three predictive models.
机构信息
Centre Hospitalier Lyon Sud, service de gynécologie-obstétrique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
出版信息
Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):334-7. doi: 10.1016/j.ejogrb.2011.05.020. Epub 2011 Jun 12.
OBJECTIVE
To evaluate three predictive risk models of non-sentinel lymph node (NSLN) involvement in the case of micrometastatic sentinel node (SLN) involvement for breast cancer.
STUDY DESIGN
This retrospective study included 72 successive patients with micrometastatic SLN involvement who had surgery between March 1996 and October 2007. All patients had undergone immediate or delayed axillary lymph node dissection (ALND). The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram, the Stanford nomogram and the Tenon score were applied to the population to calculate the probability of NSLN involvement.
RESULTS
For the MSKCC nomogram with a threshold value of 10%, sensitivity was 50%, specificity was 70% and the negative predictive value (NPV) was 89%. The area under the receiver operating characteristic curve (AUC) was 0.6 (significant). Use of this nomogram would have avoided ALND in 49 out of 72 (68%) patients, but five out of 10 (50%) patients with NSLN involvement would not have been detected. With a threshold value of 7%, the AUC was 0.69, sensitivity was 90% and NPV was 97%. ALND would have been avoided in 31 out of 72 (43%) patients, with a 3% chance of leaving metastases when abstaining from ALND. For the Tenon score with a threshold value of 3.5, sensitivity was 50%, specificity was 72% and the AUC was 0.62. This was not clinically applicable because eight out of 10 (80%) patients with NSLN involvement would not have been detected. For the Stanford nomogram, the results could not be interpreted because the AUC was not significant.
CONCLUSION
None of the tested models are sufficiently reliable for use in daily practice. The MSKCC nomogram showed the most encouraging results, especially for a threshold value of 7%, but this has not been validated in the literature. Complete axillary dissection should be performed in the case of micrometastatic SLN involvement until more data become available.
目的
评估三种预测模型在乳腺癌前哨淋巴结（SLN）微转移的情况下非前哨淋巴结（NSLN）受累的风险。
研究设计
本回顾性研究纳入了 1996 年 3 月至 2007 年 10 月间连续 72 例 SLN 微转移患者。所有患者均行即刻或延迟腋窝淋巴结清扫术（ALND）。采用 Memorial Sloan-Kettering Cancer Center（MSKCC）列线图、斯坦福列线图和 Tenon 评分计算 NSLN 受累的概率。
结果
MSKCC 列线图截断值为 10%时，敏感性为 50%，特异性为 70%，阴性预测值（NPV）为 89%。受试者工作特征曲线下面积（AUC）为 0.6（有意义）。使用该列线图可避免 72 例患者中的 49 例（68%）行 ALND，但会漏诊 10 例患者中的 5 例（50%）NSLN 受累。截断值为 7%时，AUC 为 0.69，敏感性为 90%，NPV 为 97%。可避免 72 例患者中的 31 例（43%）行 ALND，而放弃 ALND 时，漏诊转移灶的概率为 3%。Tenon 评分截断值为 3.5 时，敏感性为 50%，特异性为 72%，AUC 为 0.62。该评分不具有临床应用价值，因为会漏诊 10 例患者中的 8 例（80%）NSLN 受累。斯坦福列线图的 AUC 不显著，结果无法解读。
结论
在日常实践中，没有一种模型的可靠性足够高。MSKCC 列线图的结果最令人鼓舞，尤其是截断值为 7%时，但尚未在文献中得到验证。在前哨淋巴结微转移的情况下，应行完整的腋窝淋巴结清扫术，直到获得更多数据。
Zotero 插件