McCarter M D, Yeung H, Fey J, Borgen P I, Cody H S
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Am Coll Surg. 2001 Jun;192(6):692-7. doi: 10.1016/s1072-7515(01)00847-x.
During sentinel lymph node (SLN) biopsy for breast cancer, most authors report identifying a mean of 1 to 3 SLNs, but a range of 1 to 8 (or more) SLNs per patient. A significant minority of patients have 4 or more SLNs. Here we seek to determine the significance for the breast cancer patient of finding multiple SLNs, and whether there is an optimal threshold number of SLNs that should be removed.
1,561 patients who underwent successful SLN biopsy using blue dye and radioisotope in combination. Each SLN site was categorized prospectively by the operating surgeon as a dye success, an isotope success, or both. All SLNs containing counts at least four times greater than the postexcision axillary background were considered to be isotope successes.
Fifteen percent of patients (241) had multiple (>3) SLNs. Ninety-eight percent of node-positive patients (440 of 449) were identified within the first three SLN sites examined. In 2% of all SLN positive patients (9 of 449) or 4% of patients with multiple SLN (9 of 241), a positive SLN was detected at site four or more. In eight patients the first positive SLN was found at sites four or more. Blue dye and isotope were equally effective in identifying metastases in patients with multiple SLNs.
Fifteen percent of patients having SLN biopsy for breast cancer have multiple SLNs. Although 98% of positive SLNs were identified within the first three sites sampled, a small number of patients had their first positive SLN at sites 4 to 8. These data suggest that there is no absolute upper threshold for the number of SLNs that should be removed. Sampling a few additional SLNs probably adds little morbidity to the procedure, yet may significantly alter the treatment of some individuals. SLN biopsy should be continued until all blue and hot nodes are removed.
在乳腺癌前哨淋巴结（SLN）活检过程中，大多数作者报告平均识别出1至3个SLN，但每位患者的SLN数量范围为1至8个（或更多）。少数患者有4个或更多的SLN。在此，我们试图确定发现多个SLN对乳腺癌患者的意义，以及是否存在应切除的SLN最佳阈值数量。
1561例患者成功接受了蓝色染料和放射性同位素联合的SLN活检。每位外科医生前瞻性地将每个SLN部位分类为染料成功、同位素成功或两者皆成功。所有计数至少比切除后腋窝背景高四倍的SLN被视为同位素成功。
15%的患者（241例）有多个（>3个）SLN。98%的淋巴结阳性患者（449例中的440例）在前三个检查的SLN部位内被识别。在所有SLN阳性患者的2%（449例中的9例）或多个SLN患者的4%（241例中的9例）中，在第四个或更多部位检测到阳性SLN。在8例患者中，第一个阳性SLN在第四个或更多部位被发现。蓝色染料和同位素在识别多个SLN患者的转移灶方面同样有效。
15%接受乳腺癌SLN活检的患者有多个SLN。尽管98%的阳性SLN在最初三个采样部位内被识别，但少数患者的第一个阳性SLN在第4至8个部位。这些数据表明，应切除的SLN数量没有绝对的上限。额外采样几个SLN可能只会给手术增加很少的发病率，但可能会显著改变一些患者的治疗。应继续进行SLN活检，直到所有蓝色和热结节被切除。
