Implication of Extracapsular Invasion of Sentinel Lymph Nodes in Breast Cancer: Prediction of Nonsentinel Lymph Node Metastasis
Implication of Extracapsular Invasion of Sentinel Lymph Nodes in Breast Cancer: Prediction of Nonsentinel Lymph Node Metastasis
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DOI：
10.1007/s00268-009-0389-4
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发表时间：
2010-03-01
影响因子：
2.6
通讯作者：
Kuwano, Hiroyuki
中科院分区：
文献类型：
--
作者：
Fujii, Takaaki;Yanagita, Yasuhiro;Kuwano, Hiroyuki
术中准确诊断前哨淋巴结 (SLN) 转移灶可以选择需要腋窝淋巴结清扫术 (ALND) 的患者。然而，许多 SLN 阳性的患者并未表现出转移至其他腋窝淋巴结。在本研究中，我们调查了当 SLN 发现转移时可能决定腋窝中额外阳性淋巴结可能性的因素。对 276 例临床阴性淋巴结的乳腺癌患者进行了 SLN 活检，其中 46 例 (16.6%) SLN 阳性并接受了 ALND。这 46 例病例中有 11 例（23.9%）在非前哨淋巴结（NSLN）有额外转移。回顾这些病例的临床和病理特征并进行统计分析。我们系列中所有 NSLN 淋巴结阳性的病例均在转移性 SLN 处出现包膜外侵犯（ECI）。此外，SLN 缺乏 ECI 与 NSLN 缺乏转移显着相关（P < 0.001）。作为影响因素，原发肿瘤处没有淋巴浸润、原发肿瘤大小（< 2 cm）和转移性前哨淋巴结中的病灶大小未达到统计学显着性。其他因素，包括组织学类型、病理分级、雌激素受体状态、HER2状态和年龄，与 NSLN 的转移性受累没有显着相关。我们的结果表明，转移性 SLN 处 ECI 的存在是腋窝残留疾病的强有力的预测因子。这些发现表明，在治疗转移性前哨淋巴结而不进行 ECI 的乳腺癌患者时，可能会放弃 ALND。
Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients who require axillary lymph node dissection (ALND). However, many patients with positive SLN do not show metastasis to other axillary lymph nodes. In this study, we investigated the factors that may determine the likelihood of additional positive nodes in the axilla when metastasis is found in the SLN.SLN biopsy was performed on 276 patients with breast cancer with clinically negative nodes, of which 46 (16.6%) had positive SLNs and underwent ALND. Eleven (23.9%) of these 46 cases had additional metastasis in nonsentinel lymph nodes (NSLN). The clinical and pathological features of these cases were reviewed and statistical analysis was performed.All cases of positive nodes in NSLN in our series had extracapsular invasion (ECI) at the metastatic SLNs. Furthermore, the absence of ECI of SLN was significantly associated with the absence of metastasis in the NSLN (P < 0.001). As contributing factors, the absence of lymphatic invasion at the primary tumor, primary tumor size (< 2 cm) and foci size in the metastatic SLN fell short of reaching statistical significance. Other factors, including histological type, pathological grade, estrogen receptor status, HER2 status, and age, were not significantly associated with metastatic involvement of NSLN.Our results suggest that the presence of ECI at metastatic SLNs is a strong predictor for residual disease in the axilla. These findings imply the possibility that ALND might be foregone in the treatment of patients with breast cancer without ECI at metastatic SLNs.