Madan A K, Macareo L, Winfrey K, Beech D J
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Am Surg. 2001 Jan;67(1):71-4.
The utility of level I and II axillary lymph node dissection in women with primary tumors less than 1 cm in diameter has recently received extensive evaluation. Numerous patients undergo axillary lymph node dissection ultimately to discover no pathological involvement. This study investigates the lymph node status in T1 primary breast adenocarcinoma in our diverse patient population. A retrospective evaluation of patients treated at the Medical Center of Louisiana at New Orleans and the Tulane University Medical Center with breast adenocarcinoma less than or equal to 2 cm was performed. Demographic data and pathological reports were reviewed to obtain breast lesion size and lymph node status. One hundred sixteen patients were found to have T1 lesions. Ethnic distribution was African American 66 per cent; Caucasians 30 per cent; Hispanic 2 per cent; and Asian 3 per cent. Whereas no patients with T1a lesions had positive lymph nodes, 11 per cent of patients with T1b lesions and 36 per cent of patients with T1c lesions had positive lymph nodes. However, in our patient population no patients with tumors less than 1.0 cm. in diameter had positive lymph nodes. Although this may be due to our relatively small sample size axillary lymph node dissection may be unnecessary in this select patient population. For patients with lesions 1.0 cm and greater an axillary lymph node dissection seems to add necessary information for correct treatment in a small percentage of patients. The use of lymphatic mapping with sentinel axillary lymph node biopsy may reduce the number of unnecessary axillary dissections in early breast cancer.
对于直径小于1厘米的原发性肿瘤女性患者，I级和II级腋窝淋巴结清扫术的效用最近受到了广泛评估。许多患者最终接受腋窝淋巴结清扫术却未发现病理受累情况。本研究调查了我们多样化患者群体中T1期原发性乳腺腺癌的淋巴结状态。对在新奥尔良的路易斯安那医学中心和杜兰大学医学中心接受治疗的乳腺腺癌小于或等于2厘米的患者进行了回顾性评估。查阅人口统计学数据和病理报告以获取乳腺病变大小和淋巴结状态。发现116例患者患有T1期病变。种族分布为非裔美国人66%；白种人30%；西班牙裔2%；亚洲人3%。T1a期病变患者中无淋巴结阳性者，而T1b期病变患者中有11%以及T1c期病变患者中有36%出现淋巴结阳性。然而，在我们的患者群体中，直径小于1.0厘米的肿瘤患者无淋巴结阳性者。尽管这可能归因于我们相对较小的样本量，但在这一特定患者群体中腋窝淋巴结清扫术可能是不必要的。对于病变为1.0厘米及更大的患者，腋窝淋巴结清扫术似乎能为一小部分患者的正确治疗提供必要信息。使用淋巴绘图和前哨腋窝淋巴结活检可能会减少早期乳腺癌中不必要的腋窝清扫术数量。
