Accurate Staging with Internal Mammary Chain Sentinel Node Biopsy for Breast Cancer
Accurate Staging with Internal Mammary Chain Sentinel Node Biopsy for Breast Cancer
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DOI：
10.1245/s10434-013-3263-4
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发表时间：
2014-02-01
影响因子：
3.7
通讯作者：
Winchester, David J.
中科院分区：
文献类型：
--
作者：
Gnerlich, Jennifer L.;Barreto-Andrade, J. Camilo;Winchester, David J.
背景。虽然乳腺内链（IMC）转移是一个独立的预后预测因子，但收集IMC前哨淋巴结（SN）仍然存在争议。我们试图确定IMC淋巴结阳性的预测因素，以及IMC- sns阳性对改变分期和管理的作用。我们回顾了前瞻性收集的数据库（1997-2012），以确定在淋巴显像上检测到IMC引流并进行活检的患者。卡方检验和逻辑回归模型用于确定与IMC节点阳性相关的趋势和因素。共有122例cTis-T2cN0M0乳腺癌患者接受了IMC-SN活检。该队列的平均年龄为53岁，平均肿瘤大小为2.0 cm。IMC淋巴结的鉴别成功率为100%。没有并发症。122例患者中有14例（11%）的前哨淋巴结仅定位于IMC。总体而言，26%的患者为淋巴结阳性，122例患者中有12例（10%）为IMC-SN阳性。在腋窝阳性患者中，33%的患者IMC-SN呈阳性，而在腋窝阴性患者中，3%的患者IMC-SN呈阳性（P < 0.001）。腋窝淋巴结阳性数是IMC阳性的唯一独立预测因子（1-3个腋窝淋巴结阳性比值比16.9,95% CI 3.1-91.1; >= 4个腋窝淋巴结阳性比值比45.0,95% CI 4.0-500.7）。在所有患者中，IMC-SN阳性导致更晚期的淋巴结分类，12例患者中有4例（33%）的分期更准确。IMC-SN活检是可预测和安全的。通过IMC- sn活检识别IMC转移有可能改变乳腺癌患者的分期和辅助治疗。
Background. Although internal mammary chain (IMC) metastases are an independent predictor of prognosis, collecting IMC sentinel nodes (SN) remains controversial. We sought to determine predictors for IMC nodal positivity and the role positive IMC-SNs have on changing staging and management.Methods. We reviewed a prospectively collected database (1997-2012) to identify patients who had IMC drainage detected on lymphoscintigraphy and underwent biopsy. Chi square tests and logistic regression models were used to determine trends and factors associated with IMC node positivity.Results. A total of 122 patients with cTis-T2cN0M0 breast cancer underwent IMC-SN biopsy. Mean age of the cohort was 53 years, and mean tumor size was 2.0 cm. Identification of IMC nodes was successful in 100 % of the cases. There were no complications. Sentinel nodes mapped to the IMC alone in 14 of 122 (11 %) patients. Overall, 26 % of patients were node positive, with 12 of 122 (10 %) patients having a positive IMC-SN. In patients with a positive axilla, IMC-SN was positive in 33 % of patients, whereas in patients with a negative axilla, IMC-SN was positive in 3 % of cases (P < 0.001). The number of positive axillary nodes was the only independent predictor of IMC positivity (1-3 positive axillary nodes odds ratio 16.9, 95 % CI 3.1-91.1; >= 4 positive axillary nodes odds ratio 45.0, 95 % CI 4.0-500.7). IMC-SN positivity led to a more advanced nodal category in all patients and more accurate staging in 4 of 12 (33 %) patients.Conclusions. IMC-SN biopsy is predictable and safe. Identification of IMC metastases though IMC-SN biopsy has the potential to alter the stage and adjuvant therapy of breast cancer patients.