Higher axillary lymph node metastasis burden in breast cancer patients with positive preoperative node biopsy: may not be appropriate to receive sentinel lymph node biopsy in the post-ACOSOG Z0011 trial era
Higher axillary lymph node metastasis burden in breast cancer patients with positive preoperative node biopsy: may not be appropriate to receive sentinel lymph node biopsy in the post-ACOSOG Z0011 trial era
复制标题
术前淋巴结活检阳性的乳腺癌患者腋窝淋巴结转移负担较高：在 ACOSOG Z0011 试验时代可能不适合接受前哨淋巴结活检
DOI：
10.1186/s12957-019-1582-z
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发表时间：
2019-02-20
影响因子：
3.2
通讯作者：
Shen, Kunwei
中科院分区：
文献类型：
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作者：
Liang, Yue;Chen, Xiaosong;Shen, Kunwei
背景超声检查可疑腋窝淋巴结（ALN）且细针穿刺（FNA）结果阳性的乳腺癌患者需要接受ALN清扫（ALND），这在后ACOSOG Z0011时代尚不确定。我们的目的是评估这些患者的ALN转移负担，从而说明他们是否可以遵循ACOSOG Z0011 trial procedure.MethodsClinically，T1 - 2 N0乳腺癌患者术前ALN活检阳性（FNA组）或1 - 2个阳性前哨淋巴结（SLNB组）进行回顾性分析。比较两组间ALN转移负荷，并在某些亚型中进一步分析。临床病理因素与≥ 3个ALN转移的相关性也进行了分析。结果共纳入388例患者：FNA组202例，SLNB组186例。FNA组ALN阳性数（5.18 vs.1.77，P <0.001）和≥ 3个ALN转移的患者比例（58.42%vs.11.83%，P <0.001）均显著高于SLNB组，但与肿瘤大小、分期和分子亚型无关。FNA发现的ALN转移与≥ 3个ALN转移率高独立相关结论术前ALN活检阳性患者的ALN转移负荷高于1-2个SLN阳性患者，是≥ 3个ALN转移的最强相关因素，表明这些患者不适合在ACOSOG Z0011试验后接受SLNB。
BackgroundBreast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-ACOSOG Z0011 era. We aim to evaluate the ALN metastasis burden in these patients, thus to illustrate whether they can follow the ACOSOG Z0011 trial procedure.MethodsClinically, T1–2 N0 breast cancer patients with positive preoperative ALN biopsy (FNA group) or 1–2 positive sentinel nodes (SLNB group) were retrospectively analyzed. ALN metastasis burden was compared between the two groups, which were further analyzed in certain subtypes. An association between clinicopathological factors and ≥ 3 ALN metastasis was also analyzed.ResultsA total of 388 patients were included: 202 in the FNA group and 186 in the SLNB group. The FNA group had a significantly higher number of positive ALN (5.18 vs. 1.77,P< 0.001) and a larger proportion of patients with ≥ 3 ALN metastasis (58.42% vs. 11.83%,P< 0.001) than the SLNB group, which was not influenced by different tumor size stage and molecular subtypes. ALN metastasis identified by FNA was independently associated with a high rate of ≥ 3 ALN metastasis (OR = 6.98, 95% CI 1.95–25.02,P= 0.003).ConclusionsPatients with positive preoperative ALN biopsy had a higher ALN metastasis burden than patients with 1–2 positive SLNs, which was also the strongest factor associated with ≥ 3 ALN metastasis, indicating that these patients are not appropriate to receive SLNB in the post-ACOSOG Z0011 trial era.