Imoto S, Hasebe T
Division of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Jpn J Clin Oncol. 1999 Jan;29(1):11-5. doi: 10.1093/jjco/29.1.11.
Axillary lymph node dissection is an important procedure in the surgical treatment of breast cancer. Axillary lymph node dissection is still performed in over half of breast cancer patients having histologically negative nodes, regardless of the morbidity in terms of axillary pain, numbness and lymphedema. The first regional lymph nodes draining a primary tumor are the sentinel lymph nodes. Sentinel node biopsy is a promising surgical technique for predicting histological findings in the remaining axillary lymph nodes, especially in patients with clinically node-negative breast cancer, and a worldwide feasibility study is currently in progress.
Intraoperative lymphatic mapping and sentinel node biopsy were performed in the axilla by subcutaneous injection of blue dye (indigocarmine) in 88 cases of stage 0-IIIB breast cancer. Sentinel lymph nodes were identified by detecting blue-staining lymph nodes or dye-filled lymphatic tracts after total or partial mastectomy. Finally, axillary lymph node dissection was performed up to Levels I and II or more.
Sentinel lymph nodes were successfully identified in 65 of the 88 cases (74%). In the final histological examination, the sentinel lymph nodes in 40 cases were negative, including four cases with non-sentinel-node-positive breast cancer (specificity, 100%; sensitivity, 86%). In nine (31%) of the 29 cases with histologically node-positive breast cancer, the sentinel lymph nodes were the only lymph nodes affected. Axillary lymph node status was accurately predicted in 61 (94%) of the 65 cases.
Although it was the initial experience at the National Cancer Center Hospital East, sentinel node biopsy proved feasible and successful. This method may be a reasonable alternative to the standard axillary lymph node dissection in patients with early breast cancer.
腋窝淋巴结清扫术是乳腺癌外科治疗中的一项重要手术。超过半数组织学检查腋窝淋巴结阴性的乳腺癌患者仍需接受腋窝淋巴结清扫术，而不顾及腋窝疼痛、麻木及淋巴水肿等发病率情况。引流原发性肿瘤的第一组区域淋巴结即前哨淋巴结。前哨淋巴结活检是一种很有前景的外科技术，可用于预测其余腋窝淋巴结的组织学检查结果，尤其是临床腋窝淋巴结阴性的乳腺癌患者，目前一项全球可行性研究正在进行中。
对88例0-IIIB期乳腺癌患者于腋窝行术中淋巴管造影及前哨淋巴结活检，通过皮下注射蓝色染料（靛胭脂）进行。在全乳或部分乳腺切除术后，通过检测蓝色染色的淋巴结或充满染料的淋巴管来识别前哨淋巴结。最后，进行I级和II级或更高级别的腋窝淋巴结清扫术。
88例患者中有65例（74%）成功识别出前哨淋巴结。在最终组织学检查中，40例患者的前哨淋巴结为阴性，其中包括4例非前哨淋巴结阳性的乳腺癌患者（特异性为100%；敏感性为86%）。在29例组织学检查腋窝淋巴结阳性的乳腺癌患者中，有9例（31%）前哨淋巴结是唯一受累的淋巴结。65例患者中有61例（94%）腋窝淋巴结状态得到准确预测。
尽管这是国立癌症中心东医院的初步经验，但前哨淋巴结活检被证明是可行且成功的。该方法可能是早期乳腺癌患者标准腋窝淋巴结清扫术的合理替代方法。
