Rahusen Frans D, Meijer Sybren, Taets van Amerongen Annette H M, Pijpers Rik, van Diest Paul J
Department of Surgical Oncology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Breast J. 2003 Sep-Oct;9(5):380-4. doi: 10.1046/j.1524-4741.2003.09503.x.
A sentinel node biopsy done at the time of initial tumor resection allows for a one-stage surgical procedure. In addition, sentinel node identification may be impaired when done after a previous tumor excision. This study evaluates the sentinel node biopsy in patients with nonpalpable breast cancer and assesses whether a sentinel node biopsy for mammographically suspect breast lesions is justified when preoperative needle biopsy is inconclusive for invasive malignancy. A sentinel node biopsy was done in 67 patients with nonpalpable breast lesions after injection of radioactive tracer (intraparenchymal in 35 and subdermal in 32) and blue dye (para-areolar). A preoperative core needle biopsy was positive for malignancy in 42 patients. Thirteen patients had positive cytology or ductal carcinoma in situ (DCIS). In 12 patients the needle biopsy was nondiagnostic, but the lesions remained highly suggestive of malignancy on mammography. Sentinel node biopsy was successful in 64 patients (96%). In these, the sentinel node was both radioactive and blue in 58 patients (91%). Only 4 of 13 patients with positive cytology or DCIS on preoperative needle biopsy and only 5 of 12 patients without a preoperative diagnosis had an invasive cancer after resection. Sentinel nodes were positive for nodal metastases in 9 of 49 patients (18%) with a successful sentinel node biopsy for invasive malignancy. None of the eight patients with DCIS had nodal metastases. The sentinel node procedure avoids the potential morbidity of an axillary dissection in more than 80% of patients with nonpalpable breast cancer. A sentinel node biopsy for mammographically detected suspect breast lesions is not justified without a preoperative histologic diagnosis of invasive breast cancer.
在初次肿瘤切除时进行前哨淋巴结活检可实现一期手术。此外,先前肿瘤切除后再进行前哨淋巴结识别可能会受到影响。本研究评估了不可触及乳腺癌患者的前哨淋巴结活检,并评估当术前针吸活检对浸润性恶性肿瘤诊断不明确时,对乳腺钼靶检查可疑的乳腺病变进行前哨淋巴结活检是否合理。对67例不可触及乳腺病变患者在注射放射性示踪剂(35例为实质内注射,32例为皮下注射)和蓝色染料(乳晕旁)后进行了前哨淋巴结活检。42例患者术前粗针活检恶性结果为阳性。13例患者细胞学检查阳性或为导管原位癌(DCIS)。12例患者针吸活检无法诊断,但病变在乳腺钼靶检查中仍高度提示为恶性。64例患者(96%)前哨淋巴结活检成功。其中,58例患者(91%)的前哨淋巴结同时呈现放射性和蓝色。术前针吸活检细胞学检查阳性或为DCIS的13例患者中,仅4例在切除后发现浸润性癌;术前未明确诊断的12例患者中,仅5例在切除后发现浸润性癌。49例浸润性恶性肿瘤前哨淋巴结活检成功的患者中,9例(18%)前哨淋巴结有淋巴结转移。8例DCIS患者均无淋巴结转移。前哨淋巴结手术可避免80%以上不可触及乳腺癌患者进行腋窝清扫的潜在并发症。对于乳腺钼靶检查发现的可疑乳腺病变,在没有术前浸润性乳腺癌组织学诊断的情况下,进行前哨淋巴结活检是不合理的。