Clinicopathologic analysis of sentinel lymph node mapping in early breast cancer.
Clinicopathologic analysis of sentinel lymph node mapping in early breast cancer.
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DOI：
10.1046/j.1524-4741.2003.09304.x
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发表时间：
2003-05-01
期刊：
影响因子：
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通讯作者：
Chang, Helena R
中科院分区：
文献类型：
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作者：
Choi, Seung-Hye;Barsky, Sanford H;Chang, Helena R
腋窝淋巴结状态是预测乳腺癌患者生存率和指导辅助治疗的最重要指标。前哨淋巴结活检（SLNB）是一种微创手术，发病率低，分期腋窝淋巴结状态。在这篇文章中，我们回顾和报告我们的经验，早期乳腺癌患者谁接受SLNB在露华浓/加州大学洛杉矶分校乳腺中心。1998年9月至2000年5月，共83 SLNB在81例确诊为乳腺癌和腋窝检查阴性谁选择有SLNB作为第一步的淋巴结分期。2例患者患有双侧乳腺癌。83例SLNB用99 Tc硫胶体定位，75例用异硫兰染料定位。前瞻性收集并分析这些患者的数据。比较前哨淋巴结（SLN）阳性和阴性妇女的临床和病理特征，以确定预测SLN转移的特征。83例中，82例定位成功（98.8%）。63%的患者仅在I级发现SLN，18.3%在I级和II级发现SLN，4.9%仅在II级发现SLN。这些病例中的绝大多数（84.3%）患有T1乳腺癌，整个系列的平均尺寸为1.55 cm。23例患者（28%）有阳性前哨淋巴结，平均每例患者1.5个阳性前哨淋巴结。15例有转移检测苏木精和伊红染色和8个微转移检测免疫组化（IHC）使用抗细胞角蛋白抗体。前一组中有10人同意，后一组中有2人选择了全腋窝淋巴结清扫术（ALND）。每次ALND手术平均切除17.5个淋巴结。在7名患者（共28个淋巴结）中发现了额外的转移或微转移。3例前哨淋巴结完全阴性的患者因选择游离皮瓣重建而接受了额外的腋窝淋巴结切除术。在这些淋巴结中未检测到转移。在单变量分析中，通过IHC检测雌激素和孕激素受体（ER/PR）的缺失（p = 0.036）和淋巴/血管浸润（LVI）的存在（p = 0.002）预测早期乳腺癌患者的阳性SLN;在多变量分析中，仅LVI具有预测性（p = 0.0125）。组织学类型、核分级、肿瘤分化程度、HER-2/neu和p53状态、S期分数和DNA倍体不能预测SLN状态。术后即刻并发症不常见，完全不存在延迟并发症。由于SLNB的检出率高，分期准确，发病率低，应提供作为一个选择的妇女与小乳腺癌和临床阴性淋巴结。由于LVI阳性和ER/PR阴性状态高度预测小乳腺癌中病理学阳性的SLN，因此应在术前告知符合这些标准的女性其SLN阳性的风险，并可能受益于SLN的术中评估（冷冻切片和/或触摸准备）。
Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty-three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty-three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER-2/neu and p53 status, S-phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.