Klauber-DeMore N, Tan L K, Liberman L, Kaptain S, Fey J, Borgen P, Heerdt A, Montgomery L, Paglia M, Petrek J A, Cody H S, Van Zee K J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Surg Oncol. 2000 Oct;7(9):636-42. doi: 10.1007/s10434-000-0636-2.
Axillary lymph node status is the strongest prognostic indicator of survival for women with breast cancer. The purpose of this study was to determine the incidence of sentinel node metastases in patients with high-risk ductal carcinoma-in-situ (DCIS) and DCIS with microinvasion (DCISM).
From November 1997 to November 1999, all patients who underwent sentinel node biopsy for high-risk DCIS (n = 76) or DCISM (n = 31) were enrolled prospectively in our database. Patients with DCIS were considered high risk and were selected for sentinel lymph node biopsy if there was concern that an invasive component would be identified in the specimen obtained during the definitive surgery. Patients underwent intraoperative mapping that used both blue dye and radionuclide. Excised sentinel nodes were serially sectioned and were examined by hematoxylin and eosin and by immunohistochemistry.
Of 76 patients with high-risk DCIS, 9 (12%) had positive sentinel nodes; 7 of 9 patients were positive for micrometastases only. Of 31 patients with DCISM, 3 (10%) had positive sentinel nodes. 2 of 3 were positive for micrometastases only. Six of nine patients with DCIS and three of three with DCISM and positive sentinel nodes had completion axillary dissection; one patient with DCIS had an additional positive node detected by conventional histological analysis.
This study documents a high incidence of lymph node micrometastases as detected by sentinel node biopsy in patients with high-risk DCIS and DCISM. Although the biological significance of breast cancer micrometastases remains unclear at this time, these findings suggest that sentinel node biopsy should be considered in patients with high-risk DCIS and DCISM.
腋窝淋巴结状态是乳腺癌女性患者生存的最强预后指标。本研究的目的是确定高危导管原位癌（DCIS）和伴有微浸润的DCIS（DCISM）患者前哨淋巴结转移的发生率。
从1997年11月至1999年11月，所有因高危DCIS（n = 76）或DCISM（n = 31）接受前哨淋巴结活检的患者均被前瞻性纳入我们的数据库。DCIS患者若担心在确定性手术获取的标本中发现浸润成分，则被视为高危患者并入选前哨淋巴结活检。患者接受术中使用蓝色染料和放射性核素的定位。切除的前哨淋巴结进行连续切片，并通过苏木精和伊红染色以及免疫组织化学进行检查。
76例高危DCIS患者中，9例（12%）前哨淋巴结阳性；9例中的7例仅微转移阳性。31例DCISM患者中，3例（10%）前哨淋巴结阳性。3例中的2例仅微转移阳性。9例DCIS患者中有6例、3例DCISM患者中有3例且前哨淋巴结阳性的患者进行了腋窝淋巴结清扫术；1例DCIS患者通过传统组织学分析检测到另外一个阳性淋巴结。
本研究记录了高危DCIS和DCISM患者通过前哨淋巴结活检检测到的淋巴结微转移发生率较高。尽管目前乳腺癌微转移的生物学意义尚不清楚，但这些发现表明高危DCIS和DCISM患者应考虑进行前哨淋巴结活检。
