Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases.
Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases.
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乳腺癌前哨淋巴结中肿瘤负荷的预测价值第二梯队淋巴结转移。
DOI：
10.1155/2007/570683
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
van Diest PJ
中科院分区：
文献类型：
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作者：
van Deurzen CH;van Hillegersberg R;Hobbelink MG;Seldenrijk CA;Koelemij R;van Diest PJ
背景：浸润性乳腺癌和低量前哨淋巴结(SN)受累的患者是否需要常规腋窝淋巴结清扫术(ALND)是值得怀疑的。准确预测第二梯队淋巴结受累可以确定哪些患者最有可能受益于ALND。方法：回顾分析317例浸润性乳腺癌患者的临床资料。原发肿瘤的临床病理特征和SN被评估为第二梯队淋巴结受累的可能预测因素。结果：317例中有116例(36.6%)存在第二梯队转移。肿瘤细胞孤立组(23例)、微小转移组(10 1例)和大转移组(19 3例)第二梯队淋巴结转移的发生率分别为13%、20%和48%(p<；0.001)。根据肿瘤占SN的面积百分比，不能选择第二梯队淋巴结受累低于20%的患者亚组。然而，原发肿瘤大小为1 cm的SN-ITC或微转移患者(N=12，3.8%)均未发现第二梯队淋巴结转移。结论：准确测量SN肿瘤负荷可预测第二梯队淋巴转移。然而，即使在ITC患者中，第二梯队淋巴结也有13%受累，这证明ALND是合理的。
Background: The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND. Methods: A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement. Results: Second echelon metastases were found in 116/317 cases (36.6%). Frequency of second echelon lymph node involvement in patients with isolated tumor cells (ITC, N = 23), micro- (N = 101) and macrometastases (N = 193) was 13%, 20% and 48%, respectively (p < 0.001). Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size ≤1 cm (N = 12, 3.8%) had second echelon lymph node involvement. Conclusions: Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND.