Tousimis Eleni, Van Zee Kimberly J, Fey Jane V, Hoque Laura Weldon, Tan Lee K, Cody Hiram S, Borgen Patrick I, Montgomery Leslie L
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Am Coll Surg. 2003 Oct;197(4):529-35. doi: 10.1016/S1072-7515(03)00677-X.
Sentinel lymph node biopsy (SLNB) has proved to be an accurate alternative to complete axillary lymph node dissection (ALND) in clinically node-negative breast cancer patients. Multicentric (MC) and multifocal (MF) invasive breast cancers are considered to be relative contraindications to SLNB. We examine the accuracy of SLNB in patients with MC and MF invasive breast cancers.
From September 1996 to August 2001, a total of 3,501 patients with clinically node-negative breast cancer underwent SLNB using both blue dye and radioisotope at our institution. A total of 70 patients had MC or MF invasive breast cancer, a successful SLNB, and mastectomy for local control. All had >/=10 axillary nodes excised (including the SLN) in a planned ALND. Exclusion criteria included MC and MF in situ carcinoma; breast conservation; previous breast irradiation, ALND, or SLNB; recurrent breast cancer; neoadjuvant chemotherapy; or ALND based solely on SLNB pathologic examination. RESULTS; The incidence of axillary metastases was 54% (38 of 70). SLNB accuracy was 96% (67 of 70), sensitivity 92% (35 of 38), and false-negative rate 8% (3 of 38). All patients with an inaccurate SLNB had a dominant invasive tumor >5 cm and one patient had palpable axillary disease intraoperatively. The SLN was the only site of axillary metastasis in 37% (14 of 38). Results were compared with those of published SLNB validation studies, most of which reflect experience with single-site invasive breast cancers. No statistically significant difference was noted for accuracy, sensitivity, or false-negative rate.
SLNB accuracy in MC and MF disease is comparable with that of published validation studies. MC and MF patients with a dominant T3 tumor (>5 cm) or axillary disease palpable intraoperatively should have a concurrent formal ALND. Our retrospective data suggest SLNB may be used as a reliable alternative to conventional ALND in selected patients with MC or MF disease. Further studies in this patient population are warranted.
前哨淋巴结活检（SLNB）已被证明是临床腋窝淋巴结阴性乳腺癌患者完全腋窝淋巴结清扫术（ALND）的一种准确替代方法。多中心（MC）和多灶性（MF）浸润性乳腺癌被认为是SLNB的相对禁忌证。我们研究了SLNB在MC和MF浸润性乳腺癌患者中的准确性。
1996年9月至2001年8月，共有3501例临床腋窝淋巴结阴性乳腺癌患者在本机构接受了使用蓝色染料和放射性同位素的SLNB。共有70例患者患有MC或MF浸润性乳腺癌，SLNB成功，并接受了乳房切除术以进行局部控制。所有患者均在计划的ALND中切除了≥10个腋窝淋巴结（包括前哨淋巴结）。排除标准包括MC和MF原位癌；保乳；既往乳腺放疗、ALND或SLNB；复发性乳腺癌；新辅助化疗；或仅基于SLNB病理检查的ALND。结果：腋窝转移发生率为54%（70例中的38例）。SLNB的准确性为96%（70例中的67例），敏感性为92%（38例中的35例），假阴性率为8%（38例中的3例）。所有SLNB不准确的患者均有一个直径>5 cm的主要浸润性肿瘤，且有1例患者术中可触及腋窝病变。前哨淋巴结是37%（38例中的14例）腋窝转移的唯一部位。将结果与已发表的SLNB验证研究结果进行比较，其中大多数反映了单部位浸润性乳腺癌的经验。在准确性、敏感性或假阴性率方面未发现统计学上的显著差异。
MC和MF疾病中SLNB的准确性与已发表的验证研究相当。患有主要T3肿瘤（>5 cm）或术中可触及腋窝病变的MC和MF患者应同时进行正式的ALND。我们的回顾性数据表明，在选定的MC或MF疾病患者中，SLNB可作为传统ALND的可靠替代方法。有必要对该患者群体进行进一步研究。
