Balch Glen C, Mithani Suhail K, Richards Ken R, Beauchamp R Daniel, Kelley Mark C
Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Ann Surg Oncol. 2003 Jul;10(6):616-21. doi: 10.1245/aso.2003.05.012.
We evaluated the accuracy of sentinel lymph node dissection (SLND) in patients with stage II and III breast cancer who had received preoperative therapy.
A prospective clinical trial evaluated 122 patients who had SLND followed by axillary lymph node dissection. Thirty-two women had stage II or III breast cancer and received preoperative doxorubicin-based chemotherapy or paclitaxel and radiotherapy.
A sentinel lymph node (SLN) was identified in 31 (97%) of 32 patients. The SLN predicted the status of the axillary nodes in 30 (97%) of 31 patients. Eighteen (58%) of 31 had metastases in the SLN. Eighteen of 19 patients with axillary metastases had a tumor-positive SLN (sensitivity, 95%; false-negative rate, 5%). Eight (44%) of 18 women with metastases in the SLN also had metastases in 1 or more nonsentinel nodes.
In this relatively small study, the accuracy of SLND in women with stage II or III breast cancer treated with preoperative therapy was similar to that achieved in early-stage breast cancer. If these results are confirmed in a larger cohort, it may be feasible to substitute SLND for routine axillary lymph node dissection in this population. This approach could reduce the morbidity of surgical therapy while preserving the accuracy of axillary staging and maintaining regional control in this high-risk population.
我们评估了前哨淋巴结清扫术（SLND）在接受术前治疗的II期和III期乳腺癌患者中的准确性。
一项前瞻性临床试验评估了122例行SLND后行腋窝淋巴结清扫术的患者。32名女性患有II期或III期乳腺癌，接受了以阿霉素为基础的术前化疗或紫杉醇及放疗。
32例患者中有31例（97%）发现了前哨淋巴结（SLN）。31例患者中有30例（97%）的SLN预测了腋窝淋巴结状态。31例中有18例（58%）的SLN有转移。19例腋窝转移患者中有18例SLN肿瘤阳性（敏感性95%；假阴性率5%）。18例SLN有转移的女性中有8例（44%）在1个或更多非前哨淋巴结中也有转移。
在这项相对较小的研究中，接受术前治疗的II期或III期乳腺癌女性患者中SLND的准确性与早期乳腺癌相似。如果这些结果在更大的队列中得到证实，在该人群中用SLND替代常规腋窝淋巴结清扫术可能是可行的。这种方法可以降低手术治疗的发病率，同时保持腋窝分期的准确性并维持对这一高危人群的区域控制。
