Barillari P, Leuzzi R, D'Angelo F, Bassiri-Gharb A, Naticchioni E
IX Patologia Chirurgica, Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Rome, Italy.
Minerva Chir. 2002 Apr;57(2):129-33.
The aim of the study was to demonstrate the prognostic value of sentinel node biopsy compared to the sampling of clinically suspected nodes and lymphectomy of the 3 axillary levels. METHODS. From October 1996 to January 1999, 60 patients with breast cancer with a diameter of 4 cm or under using different procedures of axillary lymphadenectomy. Sentinel node biopsy was performed using Giuliano's technique, followed by lymph nodes larger than 5 cm (lymph node sampling) and lastly all axillary lymph nodes (axillary lymphectomy at 3 levels).
Sentinel nodes were identified in all patients and a mean of 3 sentinel nodes (range 1-5) were removed during the procedure. Histological analysis showed metastatic sentinel nodes in 21 cases. Lymph node sampling was possible in 43 patients who presented enlarged nodes. The mean number of lymph nodes removed was 6 (range 3-10). Lymph node metastasis was found in 10 patients and of these 7 had a metastatic sentinel node, whereas 3 had presented negative results. Histological tests in all 60 cases of complete axillary lymphectomy showed positive results in 4 cases confirming metastasis present in sentinel nodes.
The results show that the association of lymph node sampling can improve the efficacy of sentinel node dissection, highlighting the rare cases of false negatives. In our study, total axillary lymphectomy did not add any information to the N parameter and was resolutive in a small percentage of cases.
本研究的目的是证明前哨淋巴结活检相对于临床怀疑淋巴结取样及腋窝三个水平淋巴结清扫术的预后价值。方法：1996年10月至1999年1月，60例直径4厘米及以下的乳腺癌患者采用不同的腋窝淋巴结清扫程序。前哨淋巴结活检采用朱利亚诺技术，随后对大于5厘米的淋巴结进行取样（淋巴结取样），最后清扫所有腋窝淋巴结（三级腋窝淋巴结清扫术）。
所有患者均识别出前哨淋巴结，手术过程中平均切除3个前哨淋巴结（范围1 - 5个）。组织学分析显示21例前哨淋巴结有转移。43例出现淋巴结肿大的患者可行淋巴结取样。切除淋巴结的平均数量为6个（范围3 - 10个）。10例患者发现有淋巴结转移，其中7例前哨淋巴结有转移，而3例结果为阴性。在所有60例完整腋窝淋巴结清扫术中的组织学检查显示4例结果为阳性，证实前哨淋巴结存在转移。
结果表明，淋巴结取样联合使用可提高前哨淋巴结清扫的疗效，凸显了罕见的假阴性病例。在我们的研究中，全腋窝淋巴结清扫术并未给N参数增加任何信息，且仅在一小部分病例中具有决定性作用。
