Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastases
Prediction of tumour involvement in remaining axillary lymph nodes when the sentinel node in a woman with breast cancer contains metastases
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DOI：
10.1002/bjs.4325
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发表时间：
2003-11-01
影响因子：
9.6
通讯作者：
Clough, KB
中科院分区：
文献类型：
--
作者：
Nos, C;Harding-MacKean, C;Clough, KB
背景：在相当比例的乳腺癌患者中，前哨淋巴结是唯一累及腋窝的淋巴结。本研究的目的是确定相关因素与组织学阳性non-sentinel lymph nodes.Methods：在1997年和2002年之间，800名妇女与早期乳腺癌进行前哨淋巴结活检。在263名患者中，淋巴结含有转移瘤，其中83例通过免疫组织化学（MHC）检测到微转移瘤，40例通过苏木素、伊红和藏红（RES）染色检测到微转移瘤，以及140例巨转移瘤。所有的临床和组织学标准进行了记录和分析，参考组织学的非前哨nodel.Results：在非前哨淋巴结转移的风险是相关的在前哨淋巴结的道岔的体积。当前哨淋巴结仅包含IHC检测到的微转移细胞时，83名妇女中有5名（6.0%）涉及非前哨淋巴结，当HES检测到微转移时，40名妇女中有3名（7.5%）涉及非前哨淋巴结，而当前哨淋巴结包含HES染色的大转移时，140名妇女中有5名（39.3%）涉及非前哨淋巴结。单因素分析显示非前哨淋巴结受累与前哨淋巴结内转移类型、临床原发肿瘤大小、术前可触及腋窝淋巴结、病理原发肿瘤大小和瘤周淋巴管浸润之间存在显著相关性。在多变量分析中，前哨淋巴结内转移的类型（P < 0.001），组织学肿瘤大小大于20 mm（P = 0.017）和术前可触及腋窝淋巴结（P = 0.014）仍具有显著性。与前哨淋巴结组织学相关的临床和病理因素可以可靠地预测建议进一步腋窝清除的女性，但是还不可能确定前哨淋巴结是唯一受累淋巴结并且不需要进一步腋窝治疗的患者亚组。
Background: In a significant proportion of women with breast cancer, the sentinel node is the only involved node in the a,axilla. The purpose of this study was to identify factors associated with histologically positive non-sentinel lymph nodes.Methods: Between 1997 and 2002, 800 women with early breast cancer underwent sentinel node biopsy. In 263 patients the node contained metastases, including 83 with micrometastases detected by immunohistochemistry (IHC), 40 micrometastases detected on haematoxylin, eosin and safranine (RES) staining, and 140 macrometastases. All clinical and histological criteria were recorded and analysed with reference to histology of the non-sentinel node.Results: The risk of metastasis in the non-sentinel lymph node was related to the volume of the turnout in the sentinel node. Non-sentinel nodes were involved in five (6.0 per cent) of 83 women when the sentinel node contained only micrometastatic cells detected on IHC, and in three (7.5 per cent) of 40 women when micrometastases were detected by HES, compared with 5 5 (39.3 per cent) of 140 when the sentinel node contained macrometastases on HES staining. Univariate analysis revealed a significant association between non-sentinel node involvement and type of metastasis within the sentinel node, clinical primary turnout size, palpable axillary lymph nodes before operation, pathological primary tumour size and the presence of peritumoral lymphovascular invasion. On multivariate analysis, the type of metastasis within the sentinel node (P < 0.001), histological tumour size greater than 20 mm (P = 0.017) and the presence of palpable axillary nodes before operation (P = 0.014) remained significant.Conclusion: Clinical and pathological factors associated with sentinel node histology can reliably predict women for whom further axillary clearance is recommended, but it is not yet possible to determine a subgroup of patients in whom the sentinel node is the only involved node and for whom further axillary treatment may be unnecessary.