Combi Francesca, Andreotti Alessia, Gambini Anna, Palma Enza, Papi Simona, Biroli Alice, Zaccarelli Stefania, Ficarra Guido, Tazzioli Giovanni
Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Division of Breast Surgical Oncology, Department of Medical and Surgical Maternal-Infantile and Adult Sciences, University Hospital of Modena, Modena, Italy.
Breast Cancer (Auckl). 2021 May 10;15:11782234211014796. doi: 10.1177/11782234211014796. eCollection 2021.
Almost 50% to 70% of patients who undergo axillary lymph node dissection (ALND) because of a single metastatic sentinel lymph node (SLN) have no further metastatic nodes at the axillary histology. On these grounds, the one-step nucleic acid amplification (OSNA) nomogram was designed and validated. As a mathematical model, calculated through tumor size (expressed in millimeters) and CK19 mRNA copy number, it is thought to predict nonsentinel lymph node (NSLN) status. The aim of the study is to verify the diagnostic accuracy of the OSNA nomogram in a group of patients with macrometastatic SLN, with a retrospective analysis.
The OSNA nomogram was retrospectively applied to a group of 66 patients with macrometastatic SLN who underwent ALND. The result of the final histology of the axillary cavity was compared to the nomogram prediction. We calculated the prevalence of NSLN metastasis in patients who underwent ALND, sensitivity and specificity, negative and positive predictive value of the nomogram.
In patients with macrometastasis in SLN, the prevalence of patients with metastatic NSLN was 45%. The sensitivity of the nomogram was excellent (90%). The specificity was low (36%). Positive predictive value amounted to 54%, while negative predictive value was good (81%).
These results suggest that the OSNA nomogram is a valid instrument that can help choose the best surgical strategy for the treatment of axillary cavity. The mathematical model is useful to avoid surgery in a selected group of patients because it accurately predicts NSLN status.
因单个前哨淋巴结（SLN）转移而接受腋窝淋巴结清扫术（ALND）的患者中，近50%至70%在腋窝组织学检查中没有其他转移淋巴结。基于这些原因，设计并验证了一步核酸扩增（OSNA）列线图。作为一种通过肿瘤大小（以毫米表示）和CK19 mRNA拷贝数计算得出的数学模型，它被认为可以预测非前哨淋巴结（NSLN）状态。本研究的目的是通过回顾性分析来验证OSNA列线图在一组伴有大转移灶的SLN患者中的诊断准确性。
对一组66例伴有大转移灶的SLN且接受了ALND的患者进行回顾性应用OSNA列线图。将腋窝腔最终组织学检查结果与列线图预测结果进行比较。我们计算了接受ALND患者中NSLN转移的患病率、列线图的敏感性和特异性、阴性和阳性预测值。
在SLN发生大转移的患者中，NSLN转移患者的患病率为45%。列线图的敏感性极佳（90%）。特异性较低（36%）。阳性预测值为54%，而阴性预测值良好（81%）。
这些结果表明，OSNA列线图是一种有效的工具，可有助于选择腋窝腔治疗的最佳手术策略。该数学模型有助于避免对部分患者进行手术，因为它能准确预测NSLN状态。
