Patterns of Axillary Nodal Involvement in Breast Cancer Predictability of Level One Dissection
Patterns of Axillary Nodal Involvement in Breast Cancer Predictability of Level One Dissection
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乳腺癌中腋窝淋巴结受累的模式 一级解剖的可预测性
DOI：
10.1097/00000658-198212001-00004
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发表时间：
1982
影响因子：
9
通讯作者：
F. Rosato
中科院分区：
文献类型：
--
作者：
R. Boova;F. Rosato
分析了200例连续乳房切除术和全腋窝淋巴结清扫术的一级、二级和三级受累模式。目的是确定一级腋窝淋巴结清扫术在预测乳腺癌整个淋巴结链状态方面的准确性。第一节段定义为背阔肌至胸小肌外侧，第二节段位于胸小肌后方，第三节段位于胸小肌内侧至胸廓入口。每例患者分析的平均淋巴结数量为33个。每个级别恢复的平均节点数为：第一级14个，第二级11.5个，第三级8个。120例患者（60%）没有淋巴结受累，而80例患者有腋窝淋巴结转移。有7名患者（占全部200人的3.5%）在第2和/或第3级有阳性淋巴结，但没有转移到第1级。这代表了“跳跃”转移的发生率。表现出“跳跃”转移的组包括5.5%的患者（127例中的7例）腋窝淋巴结阴性的第一级和8.7%的患者（80例中的7例）腋窝转移继发于乳腺癌。根据作者的经验，一级淋巴结清扫是整个淋巴结链状态的准确预测。第一级的负节点表示第二级和第三级缺乏参与，准确率接近95%。
Two hundred consecutive mastectomies with total axillary dissection were analyzed for patterns of involvement at levels one, two and three. The purpose was to determine the accuracy of level one axillary dissection in predicting the status of the entire lymph node chain in carcinoma of the breast. Level one was defined as latissimus dorsi to lateral pectoralis minor; level two behind the pectoralis minor and level three medial pectoralis minor to thoracic inlet. The average number of nodes analyzed per patient was 33. The average number of nodes recovered per level was 14 at level one, 11.5 at level two and eight at level three. One hundred twenty patients (60%) had no nodal involvement, while 80 patients had metastases to axillary lymph nodes. There were seven patients (3.5% of the entire 200) who had positive nodes at levels two and/or three without metastasis to level one. This represents the incidence of “skip” metastases. The group exhibiting “skip” metastases comprise 5.5% of patients (seven of 127) with negative axillary nodes at level one and 8.7% of patients (seven of 80) with axillary metastases secondary to carcinoma of the breast. In the authors' experience, level one lymph node dissection is an accurate predictor of the status of the entire lymph node chain. Negative nodes at level one would indicate lack of involvement at levels two and three with nearly 95% accuracy.