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author:("grisella, J")
1.  Prediction of Non-Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastases: Evaluation of the Tenon Score 
Current guidelines recommend completion axillary lymph node dissection (cALND) in case of a sentinel lymph node (SLN) metastasis larger than 0.2 mm. However, in 50%–65% of these patients, the non-SLNs contain no further metastases and cALND provides no benefit. Several nomograms and scoring systems have been suggested to predict the risk of metastases in non-SLNs. We have evaluated the Tenon score.
Patients and Methods
In a retrospective review of the Swedish Sentinel Node Multicentre Cohort Study, risk factors for additional metastases were analysed in 869 SLN-positive patients who underwent cALND, using uni- and multivariate logistic regression models. A receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity of the Tenon score, and the area under the curve (AUC) was calculated.
Non-SLN metastases were identified in 270/869 (31.1%) patients. Tumour size and grade, SLN status and ratio between number of positive SLNs and total number of SLNs were significantly associated with non-SLN status in multivariate analyses. The area under the curve for the Tenon score was 0.65 (95% CI 0.61–0.69). In 102 patients with a primary tumour <2 cm, Elston grade 1–2 and SLN metastases ≤2 mm, the risk of non SLN metastasis was less than 10%.
The Tenon score performed inadequately in our material and we could, based on tumour and SLN characteristics, only define a very small group of patients in which negative non-sentinel nodes could be predicted.
PMCID: PMC3273320  PMID: 22346360
breast cancer; sentinel node; metastases
2.  Neglected aspects of false positive findings of mammography in breast cancer screening: analysis of false positive cases from the Stockholm trial. 
BMJ : British Medical Journal  1996;312(7026):273-276.
OBJECTIVES: To examine the implications of false positive results of mammography in terms of the time lag from screening and complete mammography to the point when women with false positive results are declared free of cancer; the extra examinations, biopsies, and check ups required; and the cost of these extra procedures. DESIGN: Review of women with false positive results from the Stockholm mammography screening trial. SETTING: Department of Oncology, South Hospital, Stockholm. SUBJECTS: 352 and 150 women with false positive results of mammography from the first and second screening rounds of the Stockholm trial. MAIN OUTCOME MEASURES: Extra examinations and investigations required and the cost of these procedures. RESULTS: The 352 women from the first screening round made 1112 visits to the physician and had 397 fine needle aspiration biopsies, 187 mammograms, and 90 surgical biopsies before being declared free of cancer. After six months 64% of the women (219/342) were declared cancer free. The 150 women in the second round made 427 visits to the physician and had 145 fine needle aspiration biopsies, 70 mammograms, and 28 surgical biopsies, and after six months 73% (107/147) were declared cancer free. The follow up costs of the false positive screening results were Kr2.54m (250,000 pounds) in the first round and Kr0.85m (84,000 pounds) in the second round. Women under 50 accounted for about 41% of these costs. CONCLUSIONS: The examinations and investigation carried out after false positive mammography --especially in women under 50--and the cost of these procedures are a neglected but substantial problem.
PMCID: PMC2349888  PMID: 8611781

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