Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy
Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy
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DOI：
10.1245/aso.2005.09.007
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发表时间：
2005-09-01
影响因子：
3.7
通讯作者：
Newman, LA
中科院分区：
文献类型：
--
作者：
Khan, A;Sabel, MS;Newman, LA
背景资料：关于乳腺癌前哨淋巴结（SLN）活检和新辅助化疗（CTX）的最佳顺序一直存在争议。我们报告了通过超声成像、细针穿刺活检（FNA）和SLN活检对新辅助化疗前和新辅助化疗后腋窝分期的准确性。方法：从2001年到2004年，密歇根大学综合癌症中心的91例新辅助化疗患者通过超声、超声引导下FNA活检、SLN活检或联合进行腋窝分期。结果：53例（58%）新辅助治疗前CTX SLN活检的腋窝分期为病理阴性;这些患者未接受进一步腋窝手术。在38例病例（42%）中，在就诊时通过超声引导下FNA或前哨淋巴结活检证实了腋窝转移。这38例患者在给予新辅助CTX后接受了完全腋窝淋巴结清扫术（ALND）。在这些病例中，33例进行了随访淋巴结定位，32例确定了SLN（识别率，97%）。这些病例中有三分之一在ALND上完全为淋巴结阴性。22例发现有残留转移灶，1例SLN假阴性（4.5%）。结论：超声引导下细针穿刺或SLN活检可对接受新辅助化疗的患者进行准确的腋窝淋巴结分期。在有文献记载的腋窝转移的病例中，用SLN活检重复腋窝分期可以记录新辅助化疗后的淋巴结状态。该策略通过区分就诊时淋巴结阴性的患者与已降级为淋巴结阴性的患者，优化了新辅助治疗前和新辅助治疗后的CTX分期信息，并为避免这两种患者亚群中不必要的ALND提供了可能性。
Background: There is ongoing debate regarding the optimal sequence of sentinel lymph node (SLN) biopsy and neoadjuvant chemotherapy (CTX) for breast cancer. We report the accuracy of comprehensive pre-neoadjuvant CTX and post neoadjuvant CTX axillary staging via ultrasound imaging, fine-needle aspiration (FNA) biopsy, and SLN biopsy.Methods: From 2001 to 2004, 91 neoadjuvant CTX patients at the University of Michigan Comprehensive Cancer Center underwent axillary staging by ultrasonography, ultrasound-guided FNA biopsy, SLN biopsy, or a combination of these.Results: Axillary staging was pathologically negative by pre-neoadjuvant CTX SLN biopsy in 53 cases (58%); these patients had no further axillary surgery. In 38 cases (42%), axillary metastases were confirmed at presentation by either ultrasound-guided FNA or SLN biopsy. These 38 patients underwent completion axillary lymph node dissection (ALND) after delivery of neoadjuvant CTX. Follow-up lymphatic mapping was attempted in 33 of these cases, and the SLN was identified in 32 (identification rate, 97%). One third of these cases were completely node negative on ALND. Residual metastatic disease was identified in 22 cases, and the SLN was falsely negative in 1 (4.5%).Conclusions: Patients receiving neoadjuvant CTX can have accurate axillary nodal staging by ultrasound-guided FNA or SLN biopsy. In cases of documented axillary metastasis at presentation, repeat axillary staging with SLN biopsy can document the post-neoadjuvant CTX nodal status. This strategy optimizes pre-neoadjuvant CTX and post-neoadjuvant CTX staging information by distinguishing the patients who are node negative at presentation from those who have been downstaged to node negativity and offers the potential for avoiding unnecessary ALNDs in both of these patient subsets.