Reitsamer R, Peintinger F, Prokop E, Menzel C, Cimpoca W, Rettenbacher L
Department for Breast Diseases, General Hospital Salzburg, Austria.
Eur J Surg Oncol. 2003 Apr;29(3):221-3. doi: 10.1053/ejso.2002.1320.
To evaluate the rate of axillary recurrences in sentinel lymph node (SLN) negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND).
Between May 1999 and February 2001 all patients who had primary invasive breast cancer and were SLN negative were eligible for this prospective study. SLNB was performed by using the combined method with radioactive tracer and blue dye. SLNs were examined by frozen section, standard H/E staining and immunohistochemistry staining. SLN negative patients did not receive further ALND. Follow-up was done three-monthly with clinical controls, blood samples and ultrasound of the breast and axilla. An annual mammogram was performed.
116 patients with T1 or T2 invasive breast cancer were included in this trial. All 116 patients had negative SLNs in frozen sections, in H/E staining and in immunohistochemistry staining. The mean number of removed SLNs was 2.03+/-1.22. Mean tumor size was 17.15+/-7.62 mm. Postmenopausal patients totalled 79.3 and 20.7% of patients were premenopausal. No local or axillary recurrences occurred at a mean duration of follow-up of 22.12+/-6.38 months.
The absence of axillary recurrences after SLNB without ALND in SLN negative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity. Short term results are very promising. SLNB without ALND in SLN negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumors.
评估仅行前哨淋巴结活检（SLNB）而未进一步行腋窝淋巴结清扫（ALND）的前哨淋巴结（SLN）阴性乳腺癌患者的腋窝复发率。
1999年5月至2001年2月期间，所有原发性浸润性乳腺癌且SLN阴性的患者均符合本前瞻性研究的条件。采用放射性示踪剂和蓝色染料联合法进行SLNB。通过冰冻切片、标准苏木精/伊红（H/E）染色和免疫组织化学染色检查SLN。SLN阴性的患者未接受进一步的ALND。每三个月进行一次随访，包括临床检查、血液样本采集以及乳房和腋窝超声检查。每年进行一次乳房X线摄影。
本试验纳入了116例T1或T2期浸润性乳腺癌患者。所有116例患者的冰冻切片、H/E染色和免疫组织化学染色的SLN均为阴性。切除的SLN平均数量为2.03±1.22个。平均肿瘤大小为17.15±7.62毫米。绝经后患者共79例，20.7%的患者为绝经前患者。在平均22.12±6.38个月的随访期内，未发生局部或腋窝复发。
SLN阴性乳腺癌患者在未行ALND的情况下进行SLNB后未出现腋窝复发，这支持了以下假设：SLNB准确、安全，同时手术并发症较少。短期结果非常有前景。对于肿瘤较小的乳腺癌患者群体，SLN阴性患者不行ALND的SLNB是一种出色的腋窝分期方法。
