How many sentinel lymph nodes are enough for accurate axillary staging in t1-2 breast cancer?
How many sentinel lymph nodes are enough for accurate axillary staging in t1-2 breast cancer?
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有多少个哨兵淋巴结足以在T1-2乳腺癌中进行准确的腋窝分期？
DOI：
10.4048/jbc.2011.14.4.296
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发表时间：
2011-12
影响因子：
2.4
通讯作者：
Park BW
中科院分区：
文献类型：
--
作者：
Ban EJ;Lee JS;Koo JS;Park S;Kim SI;Park BW
在乳腺癌的前哨淋巴结活检(SLNB)中，为了准确的腋窝分期需要切除多少前哨淋巴结(SLN)仍然是有争议的。我们假设可能存在一个最佳的SLN阈值数量。我们调查了应该切除多少SLN才能达到可接受的准确性并确保最低的发病率。我们回顾了2004年1月至2005年12月间328例浸润性乳腺癌患者的资料，这些患者接受了SLNB，随后进行了I级和II级腋窝完全清扫术。根据切除的SLN数目评价SLNB的假阴性率(FNR)和准确性。切除腋窝淋巴结1~14枚，平均3.0枚；腋窝淋巴结清扫10~40枚，平均17.5枚。共有111例(33.8%)患者在永久病理报告上有阳性结节。其中SLN阴性12例，SLNB总准确率为10.8%(12/111)，准确率为96.3%(316/328)。单个SLN的FNR为26.6%，2个SLN的FNR为8.0%，3个SLN的FNR为11.1%。在切除4个或更多SLN的情况下，FNR降至0%，准确率达到100%。我们的数据表明，当存在其他热门节点时，SLNB不应该只移除一个或两个最热门的节点(S)。我们还认为4个可能是切除腋窝淋巴结的最佳阈值数目，切除4个以上的淋巴结并不能提高腋窝分期的准确性。
During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity. We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated. The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%. Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy.
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