Sentinel lymphadenectomy for breast cancer in a community managed care setting.
Sentinel lymphadenectomy for breast cancer in a community managed care setting.
复制标题
在社区管理护理环境中对乳腺癌进行前哨淋巴结切除术。
DOI：
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
Tan Lr
中科院分区：
文献类型：
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作者：
Guenther Jm;M. Krishnamoorthy;Tan Lr
目的
评价术中淋巴标测和前哨淋巴结切除术（IOLM/SL）在社区管理的乳腺癌患者分期中的可行性、准确性和可重复性。
患者和方法
对145例原发性乳腺癌患者进行了为期26个月的前瞻性研究。他们在原发性乳腺癌部位接受了活体染料注射。追踪淋巴通道至前哨淋巴结，切除前哨淋巴结，连续切片并检查。然后进行I级和II级腋窝淋巴结清扫和确定性乳房手术。
结果
145例手术中有103例（71.0%）发现前哨淋巴结。103例中100例（97.1%）前哨淋巴结与非前哨淋巴结一致。3例患者（9.7%）有假阴性前哨淋巴结;在最后80例患者中没有。在28个阳性前哨淋巴结中，12个（42.9%）代表腋窝内唯一的含肿瘤淋巴结。前哨淋巴结中肿瘤的检出率显著高于非前哨淋巴结（33/50，66.0%vs54/467，11.6%，P < 0.0001）。IOLM/SL比标准腋窝淋巴结清扫术发现更多的微转移（< 2 mm）（13/33，39.6%比4/177，2.2%，P < 0.001）。42例前哨淋巴结不能被识别的患者中有9例（21.4%）有5个或更多的淋巴结转移。6例Tis原发灶患者中有2例有淋巴结转移。
讨论
IOLM/SL可准确识别最可能包含转移性疾病的前哨淋巴结。存在手术学习曲线。不成功的IOLM/SL是相当大的淋巴结转移的风险因素。无肿瘤前哨淋巴结的IOLM/SL可能需要进行正式的腋窝淋巴结清扫。该技术是可行的，经济的，并在社区管理的护理设施的背景下，可重复的，而不是把严格的要求，手术室，病理学，或核医学人员。
PURPOSE
To evaluate the feasibility, accuracy, and reproducibility of intraoperative lymphatic mapping and sentinel lymphadenectomy (IOLM/SL) in the staging of breast cancer patients in a community managed care setting.
PATIENTS AND METHODS
One hundred forty-five patients with primary breast cancer were prospectively studied over a 26-month period. They underwent vital dye injection at their primary breast cancer site. Lymphatic channels were traced to the sentinel lymph node, which was excised, serially sectioned, and examined. A level I and II axillary lymph node dissection and definitive breast surgery were then performed.
RESULTS
Sentinel nodes were identified in 103 of 145 procedures (71.0%). Sentinel and nonsentinel lymph nodes were concordant in 100 of 103 cases (97.1%). Three patients (9.7%) had falsely negative sentinel nodes; there were none in the last 80 patients. Of 28 positive sentinel nodes, 12 (42.9%) represented the only tumor-containing node within the axilla. Sentinel nodes were significantly more likely to contain tumor than nonsentinel nodes (33/50, 66.0% vs 54/467, 11.6%, P < 0.0001). IOLM/SL identified more micrometastases (< 2 mm) than standard axillary lymph node dissection (13/33, 39.6% vs 4/177, 2.2%, P < 0.001). Nine of 42 patients (21.4%) whose sentinel node could not be identified had five or more nodal metastases. Two of six patients with presumed Tis primaries had nodal metastases.
DISCUSSION
IOLM/SL accurately identifies the sentinel lymph node(s) most likely to contain metastatic disease. A procedural learning curve was present. An unsuccessful IOLM/SL was a risk factor for considerable nodal metastases. IOLM/SL with a tumor-free sentinel node may obviate a formal axillary lymph node dissection. The technique was feasible, economical, and reproducible within the context of a community managed care facility, while not placing exacting demands on operating room, pathology, or nuclear medicine personnel.