Redefining Criteria to Ensure Adequate Sentinel Lymph Node Biopsy With Dual Tracer for Breast Cancer.
Redefining Criteria to Ensure Adequate Sentinel Lymph Node Biopsy With Dual Tracer for Breast Cancer.
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重新定义标准，确保使用双示踪剂对乳腺癌进行充分的前哨淋巴结活检
DOI：
10.3389/fonc.2020.588067
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发表时间：
2020
影响因子：
4.7
通讯作者：
Lv Q
中科院分区：
文献类型：
--
作者：
Xu L;Yang J;Du Z;Liang F;Xie Y;Long Q;Chen J;Zeng H;Lv Q
背景对于乳腺癌患者的前哨淋巴结活检(SLNB)，蓝染料和放射性同位素的双重示踪与10%法则，即所有放射性计数在10%或以上的最热的结节应在体外切除。然而，放射性的截断点因可能过度切除阴性结节而受到质疑。方法为了比较不同的百分位数规则，优化SLN的识别标准，我们建立了一个数据库，前瞻性地收集了成功接受SLNB的乳腺癌患者每个SLN的放射性、蓝色染料状态和病理结果。结果从2010年8月至2019年8月，共发现1039例患者的2529个SLN。切除阳性结节16.4%(414/2,529)，过度切除阴性结节83.6%(2115/2,529)。17.9%(375/2,115)的阴性结节作为放射性热结节切除，无蓝色染色。通过逐步提高阈值每增加10%，阴性结节数减少18.2%(385/2,115)，仅有3例(1.0%)结节阳性患者(1.0%)漏诊。在切除≥2 SLN的患者中，12.3%(2 38/1,942)的阴性结节避免了不必要的切除，仅0.8%(2/2 39)的阳性患者错过了“最热的2+蓝”规则。结论采用蓝色染料和放射性同位素双重示踪剂的SLNB“40%+蓝”或“最热2+蓝”可作为减少额外结节切除的一种潜在的替代方案。尽管如此，它仍应通过前瞻性试验和长期随访进行验证。
Background For sentinel lymph node biopsy (SLNB) in patients with breast cancer, the dual tracer of blue dye and radioisotope with the 10% rule that all nodes with radioactive count of 10% or more of the hottest node ex vivo should be removed is widely accepted. However, the cut-off point of radioactivity is being questioned for possibly excessive removal of negative nodes. Methods To compare different percentile rules and optimize the criteria for identifying SLNs, we established a database which prospectively collected the radioactivity, status of blue dye and the pathological results of each SLN in breast cancer patients who successfully underwent SLNB with a combination of methylene blue and radioisotope. Results A total of 2,529 SLNs from 1,039 patients were identified from August 2010 to August 2019. 16.4% (414/2,529) positive nodes were removed at a cost of 83.6% (2115/2,529) negative nodes removed excessively. Up to 17.9% (375/2,115) negative nodes were removed as radioactively hot nodes without blue staining. By gradually increasing the threshold by each 10%, the number of negative nodes identified reduced by 18.2% (385/2,115) with only three node-positive patients (1.0%) missed to be identified using the “40% + blue” rule. In patients with ≥ 2 SLNs removed, 12.3% (238/1,942) negative nodes avoided unnecessary removal with only 0.8% (2/239) positive patients missed with the “hottest two + blue” rule. Conclusions Our data indicated that the “40% + blue” rule or the “hottest two + blue” rule for SLNB with the dual tracer of blue dye and radioisotope may be considered as a potential alternative rule to minimize extra nodes resected. Nonetheless, it should be validated by prospective trials with long-term follow-up.
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DOI：
10.1016/s1470-2045(14)70460-7
发表时间：
2014-11
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Donker M;van Tienhoven G;Straver ME;Meijnen P;van de Velde CJ;Mansel RE;Cataliotti L;Westenberg AH;Klinkenbijl JH;Orzalesi L;Bouma WH;van der Mijle HC;Nieuwenhuijzen GA;Veltkamp SC;Slaets L;Duez NJ;de Graaf PW;van Dalen T;Marinelli A;Rijna H;Snoj M;Bundred NJ;Merkus JW;Belkacemi Y;Petignat P;Schinagl DA;Coens C;Messina CG;Bogaerts J;Rutgers EJ
通讯作者：
Rutgers EJ
影响因子：
3
作者：
Arrington, Amanda K.;Kruper, Laura;Chen, Steven L.
通讯作者：
Chen, Steven L.
影响因子：
51.1
作者：
Galimberti, Viviana;Cole, Bernard F.;Goldhirsch, Aron
通讯作者：
Goldhirsch, Aron
影响因子：
3.7
作者：
Liu, Liang-Chih;Parrett, Brian M.;Leong, Stanley P. L.
通讯作者：
Leong, Stanley P. L.
影响因子：
3.8
作者：
Agnese, DM;Abdessalam, SF;Walker, MJ
通讯作者：
Walker, MJ