Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, Donadio M, Bussolati G
Department of Biomedical Sciences and Human Oncology, University of Turin, Italy.
Br J Cancer. 2003 Mar 10;88(5):702-6. doi: 10.1038/sj.bjc.6600744.
The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.
了解乳腺癌患者腋窝淋巴结（LN）的状态是治疗决策的基本前提。在本研究中，我们评估了超声（US）引导下对腋窝LN进行细针穿刺细胞学检查（FNAC）在诊断LN转移以及后续乳腺癌患者治疗中的作用。对298例确诊乳腺癌患者（267例浸润性癌和31例导管原位癌DCIS）进行了腋窝超声检查，其中95例患者在超声检查发现可疑LN后进行了FNAC。涂片采用常规细胞学染色检查。诊断不明确的病例采用抗细胞角蛋白和抗HMFG2抗体联合免疫细胞化学（ICC）染色。85例FNAC结果明确（49个LN转移阳性，36个阴性）。在267例浸润性乳腺癌患者中，49例（18%）术前腋窝LN转移诊断得到证实。这些患者可直接进行腋窝清扫。此外，术前超声引导下的FNAC对88个转移LN中的49个（55%）做出了诊断。在所有其他超声检查未发现可疑LN的患者（203例，包括31例DCIS）中，未进行FNAC检查，其中28例浸润性癌（16%）组织学检查发现LN阳性。基于这些数据，所有乳腺癌患者均应进行超声检查，并仅对超声可疑LN进行ICC支持的FNAC。这种术前方案对于筛查应直接进行腋窝清扫或辅助化疗的LN转移患者是可靠的，从而避免前哨淋巴结活检。
