Estudio de enfermedad residual axilar, tras biopsia selectiva de ganglio centinela positivo, en cáncer de mama

Resum

ABSTRACT Today, sentinel lymph node dissection has replaced as standard procedure for axilla management, in patients with breast cancer whom clinically negati- ve axilla, with the same disease control and provides information for staging, avoiding morbidity. Furthermore, when the sentinel node is positive, there is a low risk of a ecting non-sentinel lymph node. However, there is controversy about which patients we can avoid the axillary lymph node dissection. Objectives: To evaluate factors related to the presence of residual disease after positive sentinel lymph node biopsy, and to validate predictive models MSKCC and Tenon in our series. Patients and Methods: In this retrospective study, we included all patients with a positive sentinel lymph node biopsy who underwent breast cancer sur- gery in our hospital in the last 10 years.. We obtained variables in relation to the patient, the tumor and the sentinel lymph node, and univariante and mul- tivariate analysis were performed to evaluate the relationship between this variables and the presence of residual disease, building a predictive model. We applied nomograms, the MSKCC and Tenon, to our population, and the area under the receiver operating characteristic curve was calculated for each of the models. Results: The variables signi cantly related with axillary metastatic spread to non-sentinel node were: The presence of macrometastases in the sentinel lymph node (especially if there are 2 or more a ected lymph nodes), the tumor size greater than 3 cm, lympho-vascular involvement, extranodal spread, the absence of negative sentinel node, and performing a mastectomy. After multi- variate analysis we could develop a predictor formula, with the last 4 features, validating it with an external group. The MSKCC and Tenon models are also validated, obtaining ROC curve values similar to our own model. Conclusions: Both, our own model and the externals, represent a useful tool in making treatment decisions in patients with breast cancer and positive sentinel node . Always as value added to other patient and disease variables.