Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer
Clinicopathologic factors predicting involvement of nonsentinel axillary nodes in women with breast cancer
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DOI：
10.1245/aso.2003.05.020
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发表时间：
2003-04-01
影响因子：
3.7
通讯作者：
Ross, MI
中科院分区：
文献类型：
--
作者：
Hwang, RF;Krishnamurthy, S;Ross, MI
背景：目前尚不清楚哪些前哨淋巴结阳性的乳腺癌患者需要完全性腋窝淋巴结清扫。我们的目的是确定预测非哨点腋窝淋巴结（nsln）阳性患者受累的因素。方法：我们回顾了1993年至2001年8月间在本院所有行SLN活检的浸润性乳腺癌患者的记录。多变量分析用于确定sln阳性患者的临床病理特征，预测nsln的累及。结果：131例SLN阳性患者均行完全性腋窝淋巴结清扫术。多因素分析显示原发肿瘤>2 cm （P = 0.009）、SLN转移>2 mm （P = 0.024）和淋巴血管浸润（P = 0.028）是nsln阳性的独立预测因素。收获的sln数量是显著的负预测因子（P = 0.04）。在我们的模型中，基于这些因素的存在，当得分为4分时，阳性预测值为100%。结论：nsln阳性的可能性与原发肿瘤的大小、最大的SLN转移的大小以及是否存在淋巴血管侵犯有关。结合这些因素的评分系统可能有助于确定哪些患者将受益于额外的腋窝手术。
Background: It is unclear which breast cancer patients with positive sentinel lymph nodes (SLNs) require a completion axillary lymph node dissection. Our aim was to determine factors that,predict involvement of nonsentinel axillary nodes (NSLNs) in patients with positive SLNs.Methods: We reviewed the records of all patients with invasive breast cancer who underwent SLN biopsy at our institution between 1993 and August 2001. Multivariate analysis was used to identify clinicopathologic features in SLN-positive patients that predict involvement of NSLNs.Results: A total of 131 patients had a positive SLN and underwent completion axillary lymph node dissection. Multivariate analysis revealed that primary tumor >2 cm (P = .009), SLN metastasis >2 mm (P = .024), and lymphovascular invasion (P = .028) were independent predictors of positive NSLNs. The number of SLNs harvested was a significant negative predictor (P = .04). In our model, based on the presence of these factors, the positive predictive value was 100% for a score of 4.Conclusions: The likelihood of positive NSLNs correlates with primary tumor size, size of the largest SLN metastasis, and presence of lymphovascular invasion. A scoring system incorporating these factors may help determine which patients would benefit from additional axillary surgery.