How many sentinel lymph nodes are enough during sentinel lymph node dissection for breast cancer?
How many sentinel lymph nodes are enough during sentinel lymph node dissection for breast cancer?
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DOI：
10.1002/cncr.23514
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发表时间：
2008-07-01
期刊：
影响因子：
6.2
通讯作者：
Hunt, Kelly K.
中科院分区：
文献类型：
--
作者：
Yi, Min;Meric-Bernstam, Funda;Hunt, Kelly K.
背景。目前尚不清楚乳腺癌 SLN 切除过程中必须切除多少前哨淋巴结 (SLN) 才能准确预测淋巴结状态。本研究的目的是确定需要切除多少个前哨淋巴结才能进行准确的淋巴结分期，以及哪些患者和肿瘤特征会影响这个数量。方法。作者回顾了前瞻性数据库中所有患有临床肿瘤、淋巴结、转移 (TNM) T1 至 T3、N0、M0 乳腺癌患者的数据，这些患者于 1994 年至 2006 年期间在其机构接受了淋巴图谱检查。有 777 名患者至少有 1 个 SLN 呈癌症阳性。使用简单和多重分位数回归分析来确定哪些患者和肿瘤特征与阳性 SLN 的数量相关。还确定了需要解剖以检测总患者组中 99% 的阳性 SLN 所需的 SLN 基线数量。 结果。 777 名淋巴结阳性患者中去除的前哨淋巴结平均数量为 2.9 个（范围：1-13 个前哨淋巴结）。超过 99% 的阳性 SLN 在前 5 个切除的淋巴结中被发现。在单变量分析中，肿瘤组织学、患者种族、肿瘤位置和肿瘤大小显着影响需要切除的 SLN 数量，以识别 99% 的阳性 SLN。在多变量分析中，混合导管和小叶组织学、白种人种、内象限肿瘤位置和 T1 肿瘤分类显着增加了需要切除的 SLN 数量，以实现所有阳性 SLN 的 99% 恢复。结论。一般来说，手术时最多切除 5 个 SLN 可使乳腺癌患者 >99% 的阳性 SLN 恢复。目前的研究结果表明，肿瘤组织学、患者种族以及肿瘤大小和位置可能会影响这一数字。
BACKGROUND. it remains unclear how many sentinel lymph nodes (SLNs) must be removed to accurately predict lymph node status during SLN dissection in breast cancer. The objective of this study was to determine how many SLNs need to be removed for accurate lymph node staging and which patient and tumor characteristics influence this number.METHODS. The authors reviewed data for all patients in their prospective database with clinical tumor, lymph node, metastasis (TNM) T1 through T3, N0, M0 breast cancer who underwent lymphatic mapping at their institution during the years 1994 through 2006. There were 777 patients who had at least 1 SLN that was positive for cancer. Simple and multiple quantile regression analyses were used to determine which patient and tumor characteristics were associated with the number of positive SLNs. The baseline number of SLNs that needed to be dissected for detection of 99% of positive SLNs in the total group of patients also was determined.RESULTS. The mean number of SLNs removed in the 777 lymph node-positive patients was 2.9 (range, 1-13 SLNs). Greater than 99% of positive SLNs were identified in the first 5 lymph nodes removed. On univariate analysis, tumor histology, patient race, tumor location, and tumor size significantly affected the number of SLNs that needed to be removed to identify 99% of all positive SLNs. On multivariate analysis, mixed ductal and lobular histology, Caucasian race, inner quadrant tumor location, and T1 tumor classification significantly increased the number of SLNs that needed to be removed to achieve 99% recovery of all positive SLNs.CONCLUSIONS. in general, the removal of a maximum of 5 SLNs at surgery allowed for the recovery of >99% of positive SLNs in patients with breast cancer. The current findings indicated that tumor histology, patient race, and tumor size and location may influence this number.