Saiz E, Toonkel R, Poppiti R J, Robinson M J
The Arkadi M. Rywlin, M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
Cancer. 1999 May 15;85(10):2206-11. doi: 10.1002/(sici)1097-0142(19990515)85:10<2206::aid-cncr15>3.0.co;2-7.
The incidence of axillary lymph node metastases from infiltrating breast carcinomas measuring 1.0 cm or smaller reported in the literature varies from 0% (for tumors measuring < or =0.5 cm) to 27.1% (for all tumors < or =1 cm).
The authors examined all infiltrating breast carcinomas measuring 1.0 cm or smaller with axillary lymph node dissections in patients seen at their institution between January 1990 and March 1997 (117 cases) to determine the incidence of axillary lymph node metastases. All tumors were evaluated for patient age, histologic type of tumor, modified Bloom-Richardson grade, estrogen and progesterone receptor status, ploidy, S-phase fraction, and angiolymphatic vessel invasion, to determine whether there was a relation between the indicators and axillary lymph node metastases. The authors also performed immunohistochemical stains for the basement membrane components laminin and Type IV collagen on the tumors demonstrating metastases and on an equal number of size- and date-matched tumors not demonstrating metastases.
Twelve cases of infiltrating carcinoma with axillary lymph node metastases were identified (a 10.3% overall incidence of metastases). Lymph node metastases were not identified in any of the cases with tumors measuring < or =0.5 cm (24 cases). The incidence of axillary lymph node metastases for carcinomas 0.6-1.0 cm was 12.9% (12 of 93 cases). High nuclear grade was found to correlate with the presence of lymph node metastases (P = 0.007). No statistically significant correlation was found between the other indicators examined and axillary lymph node metastases or between basement membrane staining and axillary lymph node metastases.
The authors concluded that infiltrating breast carcinomas measuring < or =0.5 cm are unlikely to have demonstrable axillary lymph node metastases. Lymph node dissections in these women may be unnecessary. Nuclear grade may be the best predictor of lymph node metastases in T1b tumors.
文献报道的直径1.0 cm及以下浸润性乳腺癌腋窝淋巴结转移发生率有所不同，从0%（肿瘤直径≤0.5 cm）至27.1%（所有肿瘤直径≤1 cm）。
作者检查了1990年1月至1997年3月期间在其机构就诊的患者中所有直径1.0 cm及以下且接受腋窝淋巴结清扫的浸润性乳腺癌（117例），以确定腋窝淋巴结转移发生率。对所有肿瘤评估患者年龄、肿瘤组织学类型、改良Bloom-Richardson分级、雌激素和孕激素受体状态、倍体、S期分数以及血管淋巴管浸润情况，以确定这些指标与腋窝淋巴结转移之间是否存在关联。作者还对有转移的肿瘤以及数量相等的大小和日期匹配但无转移的肿瘤进行了基底膜成分层粘连蛋白和IV型胶原的免疫组化染色。
确定了12例伴有腋窝淋巴结转移的浸润性癌（转移总发生率为10.3%）。在任何肿瘤直径≤0.5 cm的病例中均未发现淋巴结转移（24例）。直径0.6 - 1.0 cm癌的腋窝淋巴结转移发生率为12.9%（93例中的12例）。发现高核分级与淋巴结转移的存在相关（P = 0.007）。在所检查的其他指标与腋窝淋巴结转移之间，或基底膜染色与腋窝淋巴结转移之间未发现统计学上的显著相关性。
作者得出结论，直径≤0.5 cm的浸润性乳腺癌不太可能有可证实的腋窝淋巴结转移。对这些女性进行淋巴结清扫可能没有必要。核分级可能是T1b肿瘤淋巴结转移的最佳预测指标。
