[Place of the mini-sling in the treatment of female stress urinary incontinence]

OBJECTIVE

Evaluate the place of sub-urethral mini-slings in the treatment of female stress urinary incontinence.

MATERIAL AND METHODS

Review of the literature on 43 publications (comparative and prospective studies) more than 6443 patients who underwent for the treatment of urinary incontinence, a mini-strip type TVT®, TVT-S®, MiniArc®, Ajust®, Needleless®, Solyx®, or Ophira® in comparison to the conventional urethral sling. The comparison used objective (cough stress test and pad weight test) and subjective criteria (quality of life questionnaire). The papers have also studied the complication associated with these new techniques.

RESULTS

The overall effectiveness of this surgery varied between 40 to 84% for TVT-S®, 69 to 92% for MiniArc®, 80 to 91% for Ajust®, 87% for Needleless®, 95% for Solyx® and 85% for Ophira®. The efficacy on incontinence was higher with the TVT® TVT-S® and the MiniArc® (P=0.01 to 0.05). TVT-O® efficacy was higher than TVT-S® (P<0.01 and P=0.02). Conventional slings seems to be more efficient than TVT-S® and MiniArc® mini-slings. Ajust® mini-sling seems to be as efficient as MiniArc® and TVT-S® mini-sling and TVT-O®. It showed a decrease in the intensity of postoperative pain (P<0.001), faster return to normal activities (P=0.025) and use of a common local anesthetic to the adjustable mini-sling.

CONCLUSION

It seems that the adjustable mini-sling is currently the best compromise in terms of effectiveness and complications if the choice had to be among the mini-sling in the treatment of stress urinary incontinence.

P3-07-09: Prediction of Additional Nodal Metastasis in Breast Cancer Patients with a Positive Sentinel Node Biopsy: A New Nomogram Including HER2 Status

Background

The Memorial Sloan Kettering Cancer Center-Breast Cancer Nomogram (MSKCC-BCN) predicts additional nodal metastasis in patients with positive sentinel lymph node (SLN). This statistical tool does not include HER2 status. It has been shown that the interaction covariate between estrogen receptor (ER) and HER2 status was a determinant of SLN positivity. The purpose of our study was to determine if the accuracy of MSKCC BCN could be enhanced with new variables.

Patients and methods: Our dataset consisted of 2769 consecutive patients treated for operable breast cancer with SLN biopsies between 2006 and 2009. We selected all the patients (n = 588) with a positive SLN who underwent a completion axillary lymph node dissection (ALND). The MSKCC-BCN was used to calculate the theoretical risk of additional nodal metastasis for all patients. The evaluation of the MSKCC-BCN was performed with calibration test (Cox method) and performance test (Bleeker). Multivariate analysis used a logistic regression model. The input was based on the variables found significant in the univariate analysis. Interaction covariate between ER and HER2 status was included in the model. Our model was then analyzed in terms of discrimination (area under the curve) and of calibration (Hosmer-Lemeshow test).

Results: Calibration test showed significant differences between the probability of additional nodal disease predicted by the MSKCC-BCN and the probability observed in our population for the following subgroups of patients: histological grade 3 (p= 0.007), lymphovascular invasion (p=0.03), multifocality (p=0.04), positive ER (p=0.002), micrometastasis in the SLN (p=0.003), isolated tumor cells in the SLN (p=0.02 and positive HER2 (p=0.01). Performance test showed significant differences for the following variables: histological grade (p= 0.02), size of the SLN metastasis (p=0.04) and HER2 status (p=0.01). This shows that the MSKCC-BCN is not well calibrated and cannot be used for our population. A multivariate model to determine the probability of additional nodal metastasis was defined with the following variables: pathologic size of the sentinel node metastasis, interaction covariate between the ER and HER2 status, number of positive SLN and number of SLN removed [Table 1].