The current application of ACOSOG Z0011 trial results: Is further implementation of sentinel lymph node intra-operative histopathological examination mandatory in breast cancer patients - a single-center analysis
The current application of ACOSOG Z0011 trial results: Is further implementation of sentinel lymph node intra-operative histopathological examination mandatory in breast cancer patients - a single-center analysis
复制标题
DOI：
10.4149/neo_2018_170321n202
复制
发表时间：
2018-01-01
期刊：
影响因子：
3
通讯作者：
Kolacinska, A.
中科院分区：
文献类型：
--
作者：
Nowikiewicz, T.;Zegarski, W.;Kolacinska, A.
ACOSOG Z0011试验的主要目的是确定放弃完全腋窝淋巴结清扫（ALND）对已进行保乳治疗（BCT）的前哨淋巴结（SLN）转移乳腺癌患者生存率的影响。本研究的目的是评估SLN术中组织病理学检查的临床价值。我们的研究包括1284例浸润性乳腺癌患者进行前哨淋巴结活检（SLNB）。在第一阶段（2013年7月至2014年6月）接受治疗的患者中常规进行SLN术中组织病理学评估。但是，关于术中评估的决定由外科医生为在2014年7月至2015年6月期间接受该评价并提交进行BCT的患者做出。在72.4%的患者中进行了BCT。共有316例患者（24.6%）发生了前哨淋巴结转移。在2014年7月至2015年6月期间，对20.8%提交接受BCT的患者进行了SLN术中显微镜评价。在27.5%的SLN转移患者中，ALND被忽略，而在前一阶段的患者中，ALND被忽略的比例为15.5%（p=0.0094）。接受腋窝保守治疗的SLN大转移患者比例从5.4%增加到23.1%（p=0.0007）。SLN最终组织病理学评估的选择可能允许推迟对提交SLNB的患者进行更广泛腋窝手术的决定。省略非手术进行的SLN术中组织病理学评价导致避免完全ALND的患者比例在统计学上显著增加。
The main objective of the ACOSOG Z0011 trial was to determine the impact of abandoning complete axillary lymph node dissection (ALND) on survival of breast cancer patients with sentinel node lymph (SLN) metastasis in whom breast conserving therapy (BCT) had been performed. The aim of our study was to assess the clinical value of intra-operative histopathological examination of SLN. Our study comprised 1284 invasive breast cancer patients in whom sentinel lymph node biopsy (SLNB) was carried out. SLN intra-operative histopathological assessment was routinely performed in patients treated within the first period (07.2013-06.2014). However, the decision regarding intra-operative assessment was made by the surgeon for the patients who underwent this evaluation in the later period 07.2014-06.2015 and were submitted for BCT. BCT was performed in 72.4% of patients. In total, 316 patients (24.6%) developed SLN-metastasis. Within the period 07.2014-06.2015, SLN intra-operative microscopic evaluation was performed in 20.8% of patients submitted for BCT. ALND was omitted in 27.5% of patients demonstrating SLN metastasis, in comparison with 15.5% of the group from the previous period (p=0.0094). The proportion of patients demonstrating macrometastasis in SLN who received conservative treatment to the axilla increased from 5.4% to 23.1% (p=0.0007). The choice of SLN final histopathological assessment may allow for deferral of decision on more extensive surgery of the axilla in patients submitted for SLNB. The omission of routinely-performed SLN intra-operative histopathological evaluation has led to a statistically significant increase in the proportion of patients in whom complete ALND was avoided.