Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer
Relapse and morbidity in patients undergoing sentinel lymph node biopsy alone or with axillary dissection for breast cancer
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DOI：
10.1001/archsurg.138.5.482
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发表时间：
2003-05-01
影响因子：
--
通讯作者：
Grant, CS
中科院分区：
文献类型：
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作者：
Blanchard, DK;Donohue, JH;Grant, CS
假设：单纯前哨淋巴结（SLN）活检分期的淋巴结阴性患者的腋窝复发率并不比标准腋窝淋巴结清扫术患者高。发病率较低的患者谁SLN biopsization.Design，设置和患者：1997年10月14日，2001年8月31日，1253例连续的妇女与原发性浸润性乳腺癌前瞻性进入SLN活检数据库。作为培训方案的一部分，在SLN活检后对164名患者进行了完整的腋窝淋巴结清扫术。干预措施：通过问卷调查或电话联系患者，以确定乳腺癌复发;手臂水肿，手臂疼痛，腋窝感染或血清肿形成的存在;以及肿瘤复发或死亡。主要结果测量：采用卡方检验或Fisher精确检验和Wilcoxon秩和检验分析分类变量和连续变量。结果：在1253例患者中，894例（71%）仅SLN活检阴性（n = 730 [82%]）或SLN活检+腋窝淋巴结清扫阴性（n = 164 [18%]）。776名患者（87%）完成了问卷调查。平均+/- SD随访时间为2.4 +/- 0.9年。腋窝淋巴结清扫患者报告的手臂水肿（34%）、手臂疼痛（38%）、血清肿形成（24%）和感染（9%）的发生率显著高于仅SLN活检患者（分别为6%、14%、7%和3%）。一个腋窝复发（0.1%）发生在后续的685名妇女谁接受SLN活检ONLY. CONCLUSION：中期随访，有我腋窝复发685 SLN淋巴结阴性的妇女，支持使用SLN活检作为一个准确的方法分期乳腺癌。前哨淋巴结活检的发病率明显低于腋窝淋巴结清扫术。
Hypothesis: Axillary relapse in node-negative patients staged with sentinel lymph node (SLN) biopsy alone is no more frequent than in patients treated with standard axillary dissection. Morbidity is less for patients who had SLN biopsy.Design, Setting, and Patients: Between October 14, 1997, and August 31, 2001, 1253 consecutive women with primary invasive breast cancer were prospectively entered into an SLN biopsy database. Completion axillary dissection was performed in 164 patients after SLN biopsy as part of a training protocol.Interventions: Patients were contacted by questionnaire or telephone to determine breast cancer relapse; presence of arm lymphedema, arm pain, axillary infection, or seroma formation; and tumor recurrence or death.Main Outcome Measures: chi(2) or Fisher exact tests and Wilcoxon rank sum tests were used to analyze categorical and continuous variables. Logistic regression was used to analyze morbidity.Results: Of 1253 women, 894 (71%) were node negative by SLN biopsy alone (n = 730 [82%]) or SLN biopsy and completion axillary dissection (n = 164 [18%]). Questionnaires were completed by 776 patients (87%). Mean +/- SD follow-up was 2.4 +/- 0.9 years. Patients with axillary dissections reported a significantly higher occurrence of arm lymphedema (34%), arm pain (38%), seroma formation (24%), and infection (9%) vs SLN biopsyonly patients (6%, 14%, 7%, and 3%, respectively). One axillary relapse (0.1%) occurred during follow-up of 685 women who underwent SLN biopsy only.Conclusions: With intermediate-term follow-up, there was I axillary recurrence in 685 SLN node-negative women, supporting use of SLN biopsy as an accurate method for staging breast cancer. Biopsy of the SLN was associated with significantly less morbidity than completion axillary dissection.