Feldman S M, Krag D N, McNally R K, Moor B B, Weaver D L, Klein P
Department of Surgery, Benedictine Hospital, Kingston, NY, USA.
J Am Coll Surg. 1999 Mar;188(3):248-54. doi: 10.1016/s1072-7515(98)00306-8.
Radiolocalization and selective biopsy of the sentinel node to correctly predict the status of remaining lymph nodes may provide an alternative to axillary dissection in selected breast cancer patients with clinically negative lymph nodes.
In a nonrandomized, multicenter clinical trial, gamma probe localization for lymphatic mapping and sentinel node biopsy along with axillary dissection was performed on 75 patients with invasive breast cancer and clinically negative lymph nodes. The accuracy of the sentinel node biopsy to correctly predict the status of the remaining axillary lymph nodes was established through standard pathologic investigation.
A sentinel node was identified in 70 of 75 patients with a technical success rate of 93%. Of these 70 patients, 21 (30%) had axillary nodal metastases identified pathologically. Four of these 21 (19%) had sentinel nodes negative for metastases. All 4 false-negative patients had prior excisional biopsies. The false-negative group had a larger mean maximal biopsy dimension than the true-positive group. Eleven of the 21 patients with axillary metastases had a diagnosis made by core needle biopsy with no false negatives.
The accuracy of the sentinel node biopsy in correctly predicting the status of remaining axillary lymph nodes may be limited in patients with large excision before radiolocalization of the sentinel node. Our findings suggest that excisional biopsy should be avoided prior to lymphatic mapping for sentinel node biopsy.
前哨淋巴结的放射性定位和选择性活检以正确预测其余淋巴结状态，可能为部分临床腋窝淋巴结阴性的乳腺癌患者提供腋窝清扫术的替代方案。
在一项非随机、多中心临床试验中，对75例浸润性乳腺癌且临床腋窝淋巴结阴性的患者进行了γ探针定位淋巴绘图和前哨淋巴结活检以及腋窝清扫术。通过标准病理检查确定前哨淋巴结活检正确预测其余腋窝淋巴结状态的准确性。
75例患者中有70例识别出前哨淋巴结，技术成功率为93%。在这70例患者中，21例（30%）经病理检查发现有腋窝淋巴结转移。这21例中有4例（19%）前哨淋巴结转移阴性。所有4例假阴性患者之前均接受过切除活检。假阴性组的平均最大活检尺寸大于真阳性组。21例有腋窝转移的患者中有11例通过粗针活检确诊，无假阴性。
在前哨淋巴结放射性定位之前进行过大范围切除的患者中，前哨淋巴结活检正确预测其余腋窝淋巴结状态的准确性可能会受到限制。我们的研究结果表明，在进行前哨淋巴结活检的淋巴绘图之前应避免切除活检。
