Turner R R, Chu K U, Qi K, Botnick L E, Hansen N M, Glass E C, Giuliano A E
Joyce Eisenberg Keefer Breast Center and the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Cancer. 2000 Aug 1;89(3):574-81. doi: 10.1002/1097-0142(20000801)89:3<574::aid-cncr12>3.0.co;2-y.
To the authors' knowledge it has not yet been determined which patients with primary breast carcinoma and an axillary sentinel lymph node (SN) metastasis have additional metastases in nonsentinel lymph nodes.
Pathologic features of the primary breast carcinoma and its SN metastasis were examined in 194 patients and correlated with the tumor status of the non-SNs in the same axillary basin. Two-level cytokeratin immunohistochemistry was applied to the SNs and to non-SNs of cases that were negative by standard hematoxylin and eosin examination.
Lymph node staging based on SN findings, size of the primary tumor, and presence of peritumoral lymphatic vascular invasion (LVI) were associated with non-SN metastasis. The majority (63%) of the 101 patients with SN macrometastases had non-SN metastases. Extranodal hilar tissue invasion in conjunction with SN involvement also was strongly associated with non-SN metastasis (P = 0.0001) but was present in only 65% of patients (35 of 54 patients) with non-SN macrometastases. Approximately 26% of patients (24 of 93 patients) with SN micrometastases (</= 2.0 mm) had non-SN metastases; among these patients only primary tumor size and peritumoral LVI were correlated with non-SN metastasis.
Detailed pathologic examination of the primary tumor and its SN metastasis may increase precision in the selection of patients for further axillary surgery or radiation therapy.
据作者所知,尚未确定哪些原发性乳腺癌且腋窝前哨淋巴结(SN)转移的患者在非前哨淋巴结中有额外转移。
对194例患者的原发性乳腺癌及其SN转移的病理特征进行检查,并与同一腋窝区域非前哨淋巴结的肿瘤状态相关联。对标准苏木精和伊红检查为阴性的病例的SN和非SN进行二级细胞角蛋白免疫组化检查。
基于SN结果、原发肿瘤大小和肿瘤周围淋巴管侵犯(LVI)的淋巴结分期与非前哨淋巴结转移相关。101例SN大转移患者中的大多数(63%)有非前哨淋巴结转移。结外肺门组织侵犯合并SN受累也与非前哨淋巴结转移密切相关(P = 0.0001),但仅在65%(54例中的35例)有非前哨淋巴结大转移的患者中出现。约26%(93例中的24例)SN微转移(≤2.0 mm)的患者有非前哨淋巴结转移;在这些患者中,仅原发肿瘤大小和肿瘤周围LVI与非前哨淋巴结转移相关。
对原发肿瘤及其SN转移进行详细的病理检查可能会提高选择进一步腋窝手术或放疗患者的准确性。