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Master Thesis

Évaluation des nomogrammes dans la prise en charge des cancers du sein à un stade précoce

Abstract : Background and aims: Since the introduction of the sentinel node biopsy in the treatment of early breast cancer, the axillary lymph node dissection became the norm in case of sentinel node métastatic. Although it is associated with an important risk of nervous complications of the upper limb and lymphoedema. The use of scores or abacuses, allowed the deletion of axillary lymph node dissection on patients with good pronostic. Scores and abacuses were developed to estimate the risk of invasion of sentinels and non sentinels lymph node, in agreement with the biological or histological characteristics of the tumor or the sentinel lymph node. The main objective of this study was to estimate the diagnostic precision of three scores: the nomogramme of the MSKCC for the prediction of invasion of sentinel lymph node and the second nomogramme of the MSKCC and finally the score of Tenon for the invasion of non sentinel lymph node. Patients and method: We realized a forward-looking study, bicentrique, non-interventional, which took place between January and December, 2014, in two hospitals of Paris area. We included all patients with an infiltrating carcinoma, having a total or partial mastectomy associated with a biopsy of the sentinel lymph node. The diagnostic reference was the definitive histological examination. The values of the various items were attributed to every patient included in the study, according to the meditative criteria which allowed the calculation of every score for every patient. Results: One hundred and seventy-nine patients were included. For the calculation of the risk of invasion of the sentinel lymph node with the nomogramme of MSKCC, the area under the curve ROC was 0,65 (IC95%0,57-0,73) and the negative predictive value (VPN) of 83,9 % (IC95%76,7-89,7). For the calculation of the risk of invasion of non sentinel lymph nodes; with the score of Tenon the area under the curve ROC was 0,49 (IC95%0,31-0,68) and VPN of 75 % (IC95 % 47,6-92,7). With the score of MSKCC, the area under the curve ROC was 0,52 (IC95%0,41-0,625) and VPN of 76,3 % (IC95%55,8-89,6). Conclusion: Our results show that the precision of these nomograms on an other population than the one where they were conceived is not very conclusive tu be used in routine on our population. This raises a question concerning the utility of these nomogramms, at a moment when the tendency is in therapeutic de-escalation, with studies showing a survival not changed, with or without lymph node dissection on the patients with limited attack of the sentinel lymph node.
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Master Thesis
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Submitted on : Friday, April 22, 2016 - 10:33:31 AM
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Alice Clavier. Évaluation des nomogrammes dans la prise en charge des cancers du sein à un stade précoce. Médecine humaine et pathologie. 2015. ⟨dumas-01305989⟩

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