Multicenter validation of two nomograms to predict non-sentinel node involvement in breast cancer.

INTRODUCTION: Nomograms are used to predict the involvement of non-sentinel nodes (nSN) in breast cancer. This study attempts to externally validate two of the more commonly used nomograms (MSKCC and Stanford University). MATERIALS AND METHODS: Five hundred and one cases of positive SNB with posterior axillary lymphadenectomy from 11 Spanish hospitals with widespread experience of the technique were studied. In all cases, an estimate of the probability of nSN involvement was made using the MSKCC and the Stanford University nomograms. Discrimination was assessed by calculating the area under the receiver operating characteristic curve. To assess the calibration of the nomogram, observed probability was plotted against the nomogram-calculated predicted probability. RESULTS: The overall predictive accuracy of the MSKCC nomogram was 0.684 (95 % confidence interval, 0.635-0.732), while in the case of that from Stanford the predictive accuracy was 0.658 (95 % confidence interval 0.607-0.709). The mean predicted probability of nSN metastases in each group of patients was correlated with the observed probability with an acceptable concordance (r = 0.820; p < 0.004 in MSKCC nomogram and r = 0.888; p < 0.001 in Stanford nomogram). CONCLUSION: These nomograms can be useful tools in the evaluation of patients with breast cancer and positive sentinel nodes but other factors, including a comprehensive clinical assessment, must be used to decide the most appropriate surgical approach for an individual patient, especially with regard to avoiding unnecessary lymphadenectomy.

[Our experience of the clinical application of sentinel node biopsy in breast cancer]. / Nuestra experiencia en la aplicación clínica de la biopsia del ganglio centinela en cáncer de mama.

INTRODUCTION: Systematical lymphadenectomy has been replaced by selective sentinel node biopsy in the initial staging of early breast cancer. The aim of this study was to assess the accuracy of the technique in its application phase, paying special attention to the follow-up of patients with negative sentinel node who did not undergo axillary lymphadenectomy. PATIENTS AND METHOD: A total of 168 patients with 169 stage I and II breast cancer lesions underwent sentinel lymph node biopsy in its application phase. The procedure was previously validated by our group and included lymphoscintigraphy performed with periareolar or intratumoral injection of 99mTc stannous colloid, and radioguided surgical detection on the following day. RESULTS: Lymphoscintigraphic sentinel node localization was successful in 95.3% of the lesions (161/169) and axillary surgical detection in 90.5% (153/169), with 1.1 nodes excised per patient (range 1-4). Malignancy was found in 30.1% of the sentinel nodes removed (46/153), 11 of which were micrometastases (23.9%). Subsequent axillary dissection revealed that the sentinel node was the only node involved in 22/46 (47.8%). The sentinel node was found to be negative in the remaining 107/153 lesions (69.9%), and surgical treatment was considered to be complete. To date, the mean follow-up of the patients has been 20.4 months (range 3-49), and no axillary recurrences have been observed. Of the entire group, four patients developed distant metastases; one had concomitant mammary recurrence and died. CONCLUSIONS: Application of sentinel node biopsy is safe and has improved our RESULTS: This technique allows correct staging and probably maintains local control of the disease.

Nuestra experiencia en la aplicación clínica de la biopsia del ganglio centinela en cáncer de mama / Our experience of the clinical application of sentinel node biopsy in breast cancer

Introducción. La biopsia selectiva del ganglio centinela ha sustituido a la linfadenectomía sistemática en la estadificación del cáncer de mama en estadios precoces. El objetivo de este estudio ha sido evaluar la eficacia de la técnica en fase de aplicación clínica, con especial interés en el seguimiento de las pacientes con ganglio centinela negativo, a las que no se realizó vaciamiento axilar. Pacientes y método. Se realizó biopsia del ganglio centinela en fase de aplicación clínica a 168 pacientes con 169 lesiones malignas de mama en estadios I y II. Se siguió el procedimiento previamente validado por nuestro grupo, que incluye gammagrafía tras inyección periareolar o intratumoral de coloide de estaño-99mTc, y detección quirúrgica radioguiada el día siguiente. Resultados. La localización gammagráfica del ganglio centinela se consiguió en 161 (95,3%) de los 169 casos, y la exéresis quirúrgica axilar, en 153 (90,5%). Se extrajo 1,1 ganglio por paciente (rango, 1-4). El ganglio centinela fue positivo en 46 (30,1%) de los 153 casos; 11 eran micrometástasis (23,9%). El vaciamiento axilar posterior reveló que dicho ganglio era el único afectado en 22 (47,8%) de los 46 casos. El ganglio centinela resultó negativo en los restantes 107 (69,9%) casos, por lo que se dio por finalizado el procedimiento quirúrgico. El seguimiento medio de las pacientes ha sido de 20,4 (rango, 3-49) meses, sin que haya aparecido hasta el momento ninguna recidiva axilar. De todo el grupo, 4 pacientes han desarrollado metástasis a distancia, una de ellas presentó recidiva mamaria concomitante y, posteriormente, falleció. Conclusiones. La biopsia selectiva del ganglio centinela se está aplicando con seguridad, incluso han mejorado nuestros resultados previos, permite una estadificación correcta y probablemente mantiene el control local de la enfermedad (AU)

Introduction. Systematical lymphadenectomy has been replaced by selective sentinel node biopsy in the initial staging of early breast cancer. The aim of this study was to assess the accuracy of the technique in its application phase, paying special attention to the follow-up of patients with negative sentinel node who did not undergo axillary lymphadenectomy. Patients and method. A total of 168 patients with 169 stage I and II breast cancer lesions underwent sentinel lymph node biopsy in its application phase. The procedure was previously validated by our group and included lymphoscintigraphy performed with periareolar or intratumoral injection of 99mTc stannous colloid, and radioguided surgical detection on the following day. Results. Lymphoscintigraphic sentinel node localization was successful in 95.3% of the lesions (161/169) and axillary surgical detection in 90.5% (153/169), with 1.1 nodes excised per patient (range 1-4). Malignancy was found in 30.1% of the sentinel nodes removed (46/153), 11 of which were micrometastases (23.9%). Subsequent axillary dissection revealed that the sentinel node was the only node involved in 22/46 (47.8%). The sentinel node was found to be negative in the remaining 107/153 lesions (69.9%), and surgical treatment was considered to be complete. To date, the mean follow-up of the patients has been 20.4 months (range 3-49), and no axillary recurrences have been observed. Of the entire group, four patients developed distant metastases; one had concomitant mammary recurrence and died. Conclusions. Application of sentinel node biopsy is safe and has improved our results. This technique allows correct staging and probably maintains local control of the disease (AU)

Diverticulitis yeyunal. Una causa poco frecuente de abdomen agudo / Jejunal diverticulitis. A rare cause of acute abdomen

Los divertículos yeyunoileales no meckelianos se diagnostican con más frecuencia en varones > 50 años. Son una causa muy poco frecuente de abdomen agudo. Habitualmente asintomáticos, se estima que se producen complicaciones en un 10-20% de ellos. Presentamos 1 caso diagnosticado recientemente en un paciente de 82 años atendido en nuestro centro (AU)

Non-Meckelian jejunoileal diverticula are more frequently diagnosed in men aged more than 50 years old. They are a rare cause of acute abdomen. They are usually asymptomatic and are estimated to cause complications in 10-20% of cases. We present the recently diagnosed case of an 82-year-old man admitted to our hospital (AU)

[Jejunal diverticulitis. A rare cause of acute abdomen]. / Diverticulitis yeyunal. Una causa poco frecuente de abdomen agudo.

Non-Meckelian jejunoileal diverticula are more frequently diagnosed in men aged more than 50 years old. They are a rare cause of acute abdomen. They are usually asymptomatic and are estimated to cause complications in 10-20% of cases. We present the recently diagnosed case of an 82-year-old man admitted to our hospital.