The sentinel node in breast cancer - A multicenter validation study
The sentinel node in breast cancer - A multicenter validation study
复制标题
DOI：
10.1056/nejm199810013391401
复制
发表时间：
1998-10-01
影响因子：
158.5
通讯作者：
Beitsch, P
中科院分区：
文献类型：
--
作者：
Krag, D;Weaver, D;Beitsch, P
背景：初步研究表明，探针引导切除放射性前哨淋巴结（第一个接受肿瘤引流的淋巴结）可以识别乳腺癌患者的区域转移。为了证实这一发现，我们进行了一项多中心研究的方法所使用的11名外科医生在各种实践settings.Methods我们招募了443例乳腺癌患者。该技术包括将4 ml锝-99 m硫胶体（1 mCi [37 MBq]）注射到肿瘤或活检腔周围的乳房中。代表潜在前哨淋巴结的“热点”用伽马探针识别。切除热点下的前哨淋巴结。结果443例患者中，413例患者的热点识别率为93%。前哨淋巴结的病理状态进行了比较，其余腋窝淋巴结。前哨淋巴结对腋窝淋巴结阳性或阴性状态的准确性为97%（405例中的392例）;该方法的特异性为100%，阳性预测值为100%，阴性预测值为96%（304例中的291例），灵敏度为89%（114例中的101例）。前哨淋巴结位于腋窝外的病例占8%，位于1级淋巴结外的病例占11%。3%的阳性前哨淋巴结位于非腋窝位置。结论前哨淋巴结活检可以预测乳腺癌患者腋窝淋巴结转移的存在或不存在。然而，该手术在技术上可能具有挑战性，成功率根据外科医生和患者的特征而有所不同。（N Engl J Med 1998; 339：941-6.）（C）1998年，马萨诸塞州医学会。
Background Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings.Methods We enrolled 443 patients with breast cancer. The technique involved the injection of 4 mi of technetium-99m sulfur colloid (1 mCi [37 MBq]) into the breast around the tumor or biopsy cavity. "Hot spots" representing underlying sentinel nodes were identified with a gamma probe. Sentinel nodes subjacent to hot spots were removed. All patients underwent a complete axillary lymphadenectomy.Results The overall rate of identification of hot spots was 93 percent (in 413 of 443 patients). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The accuracy of the sentinel nodes with respect to the positive or negative status of the axillary nodes was 97 percent (392 of 405); the specificity of the method was 100 percent, the positive predictive value was 100 percent, the negative predictive value was 96 percent (291 of 304), and the sensitivity was 89 percent (101 of 114). The sentinel nodes were outside the axilla in 8 percent of cases and outside of level 1 nodes in 11 percent of cases. Three percent of positive sentinel nodes were in nonaxillary locations.Conclusions Biopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient. (N Engl J Med 1998; 339:941-6.) (C)1998, Massachusetts Medical Society.