Sentinel lymphadenectomy in breast cancer
Sentinel lymphadenectomy in breast cancer
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DOI：
10.1200/jco.1997.15.6.2345
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发表时间：
1997-06-01
影响因子：
45.3
通讯作者：
Statman, R
中科院分区：
文献类型：
--
作者：
Giuliano, AE;Jones, RC;Statman, R
目的：我们之前证明使用前哨淋巴结切除术（SLND）和免疫组织化学可以增加腋窝转移的检出率。这些方法已经发展，我们现在报告我们目前对这些技术的使用以及 SLND 腋窝分期的最新结果。 患者和方法： 107 名连续患有乳腺癌的女性（以前未报告）接受了 SLND，然后完成腋窝淋巴结切除术 (ALND)。所有前哨淋巴结均在术中用冰冻切片进行检查，术后用苏木精和伊红染色（H&E）以及使用细胞角蛋白抗体的免疫组织化学染色（IHC）进行检查。对非前哨腋窝淋巴结进行 H&E 检查，但不进行 IHC 检查。结果：中位年龄为 56.6 岁（范围为 28 至 90 岁），大多数患者（58.9%）已绝经，大多数原发肿瘤（62.6%）可触及，大多数手术（86.9%）为保乳。平均肿瘤大小为 2.11 +/- 1.38 cm。 100 名患者中发现前哨淋巴结：42 名患者出现前哨淋巴结转移；其中，28 例 (66.7%) 没有其他受累腋窝淋巴结，平均检查 1.8 +/- 1.1 个前哨淋巴结，并切除 20.3 +/- 7.8 个非前哨淋巴结。在七名未发现前哨淋巴结的患者中，六名腋窝肿瘤呈阴性。 SLND 可以 100% 预测这 100 名女性的腋窝状况。结论：在这批乳腺癌患者中，冰冻切片和 IHC 的 SLND 是一种微创、高度准确的术中腋窝分期方法。我们正在评估是否取消前哨淋巴结阴性女性的常规 ALND，以尽量减少与标准解剖相关的发病率。无需进行 ALND 即可识别淋巴结阴性患者的能力对于女性乳腺癌的治疗来说将是一个受欢迎的补充。 (C) 1997 年，美国临床肿瘤学会。
Purpose: We previously demonstrated increased detection of axillary metastases using sentinel lymphadenectomy (SLND) and immunohistochemistry. These methods have evolved and we now report our current use of these techniques and our most recent results of axillary staging with SLND.Patients and Methods: One hundred seven consecutive women (previously unreported) with breast cancer underwent SLND followed by completion axillary lymphadenectomy (ALND). All sentinel nodes were examined intraoperatively with frozen section and postoperatively with hematoxylin and eosin staining (H&E) plus immunohistochemical staining (IHC) using antibody to cytokeratin. The nonsentinel axillary nodes were examined with H&E, but not IHC.Results: The median age was 56.6 years (range, 28 to 90), Most patients (58.9%) were postmenopausal, most primary tumors (62.6%) were palpable, and most operations (86.9%) were breast-conserving. The mean tumor size was 2.11 +/- 1.38 cm. Sentinel nodes were identified in 100 patients: 42 patients had metastases in sentinel nodes; of these, 28 (66.7%) had no other involved axillary nodes, On average, 1.8 +/- 1.1 sentinel nodes were examined and 20.3 +/- 7.8 nonsentinel nodes were removed. Of seven patients with no identified sentinel nodes, six had a tumor-negative axilla. SLND was 100% predictive of axillary status in these 100 women,Conclusion: In this population of breast cancer patients, SLND with frozen section and IHC was a minimally invasive, highly accurate intraoperative method of axillary staging. We are evaluating the elimination of routine ALND for sentinel-node negative women to minimize the morbidity associated with standard dissections. The ability to identify node-negative patients without ALND would be a welcome addition to the management of women with breast cancer. (C) 1997 by American Society of Clinical Oncology.