Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer
Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patients with sentinel node-negative breast cancer
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DOI：
10.1200/jco.2000.18.13.2553
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发表时间：
2000-07-01
影响因子：
45.3
通讯作者：
Turner, RR
中科院分区：
文献类型：
--
作者：
Giuliano, AE;Haigh, PI;Turner, RR
目的：前哨淋巴结切除术（SLND）后立即进行完全腋窝淋巴结切除术（ALND）已证实，肿瘤阴性前哨淋巴结可准确预测乳腺癌无肿瘤腋窝淋巴结。因此，我们假设，SLND单独在肿瘤阴性的前哨淋巴结的患者将实现腋窝控制，以最小的并发症。患者和方法：1995年10月和1997年7月之间，133名连续的妇女谁有原发性浸润性乳腺肿瘤临床直径小于或等于4厘米，没有腋窝淋巴结病前瞻性地进入SLND使用活性蓝染料的试验。前哨淋巴结通过标准显微镜或免疫组织化学检查。如果前哨淋巴结无肿瘤，SLND是唯一的腋窝手术。完成ALND仅在前哨淋巴结包含转移或未发现转移时进行。从后续分析中排除了未被怀疑的多灶性癌患者和拒绝完成ALND的患者。结果：133例SLND中132例（99%）发现前哨淋巴结。8例患者被排除在进一步分析之外。在125例可评估患者中，57例具有肿瘤阳性前哨淋巴结，1例标测手术不成功;这些患者接受了完整ALND，在其余67例患者（54%）中，SLND是唯一的腋窝手术。并发症发生在20例（35%）SLND后接受ALND，但只有两例（3%）接受SLND单独（P = 0.001），有没有局部或腋窝复发在中位随访39 months.Conclusion：并发症风筝后SLND单独可以忽略不计。没有腋窝复发支持SLND作为乳腺癌的准确分期替代方案，并表明常规ALND可以消除组织病理学阴性前哨淋巴结的患者。J Clin Oncol 18：2553-2559（C）2000，美国临床肿瘤学会。
Purpose: Immediate complete axillary lymphadenectomy (ALND) after sentinel lymphadenectomy (SLND) has confirmed that tumor-negative sentinel nodes accurately predict tumor-free axillary nodes in breast cancer. Therefore, we hypothesized that SLND alone in patients with tumor-negative sentinel nodes would achieve axillary control, with minimal complications.Patients and Methods: Between October 1995 and July 1997, 133 consecutive women who had primary invasive breast tumors clinically less than or equal to 4 cm in diameter and no axillary lymphadenopathy were prospectively entered onto a trial of SLND using vital blue dye. Sentinel nodes were examined by standard microscopy or immunohistochemistry. SLND wets the only axillary surgery if sentinel nodes were tumor-free. Completion ALND was performed only if sentinel nodes contained metastases or if they were not identified. Excluded from subsequent analysis were patients with unsuspected multifocal carcinoma and those who refused completion ALND. The complication and axillary recurrence rates after SLND without ALND were determined.Results: Sentinel nodes were identified in 132 (99%) of 133 patients. Eight patients were excluded from further analysis. Of the 125 assessable patients, 57 had tumor-positive sentinel nodes and one had an unsuccessful mapping procedure; these patients underwent completion ALND, In the remaining 67 patients (54%), SLND was the only axillary procedure. Complications occurred in 20 patients (35%) undergoing ALND after SLND but in only two patients (3%) undergoing SLND alone (P =.001), There were no local or axillary recurrences at a median follow-up of 39 months.Conclusion: Complication Kites are negligible after SLND alone. An absence of axillary recurrences supports SLND as an accurate staging alternative for breast cancer and suggests that routine ALND can be eliminated for patients with histopathologically negative sentinel nodes. J Clin Oncol 18:2553-2559 (C) 2000 by American Society of Clinical Oncology.