Reitsamer R, Peintinger F, Prokop E, Rettenbacher L, Menzel C
Department of Senology, University Hospital Salzburg, Paracelsus Private Medical School Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
Br J Cancer. 2004 Apr 19;90(8):1551-4. doi: 10.1038/sj.bjc.6601765.
The aim of this study is 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 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V) and technetium 99m-labelled albumin (Nanocoll). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 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 than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.
本研究的目的是评估前哨淋巴结活检（SLNB）后未进行进一步腋窝淋巴结清扫（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2002年2月，333例连续的原发性浸润性乳腺癌患者（肿瘤最大径达4 cm且腋窝临床阴性）纳入了这项前瞻性研究。采用专利蓝V（蓝色染料）和99m锝标记白蛋白（纳米胶体）联合法识别前哨淋巴结。前哨淋巴结通过冰冻切片、苏木精-伊红染色及免疫组化染色进行检查。SLN阳性患者进行ALND。SLN阴性患者未进一步行ALND。前哨淋巴结识别率为98.5%（333例中的328例）。328例患者中，128例（39.0%）SLN阳性并接受了完整的ALND。328例患者中，共有200例（61.0%）SLN阴性且未进一步行ALND。SLN阴性患者的平均肿瘤大小为16.5 mm。每位患者切除的前哨淋巴结平均数量为2.1个。中位随访36个月时无局部或腋窝复发。SLN阴性乳腺癌患者SLNB后未行ALND而无腋窝复发，支持了这样的假设，即SLNB准确、安全，且手术并发症比ALND少。短期结果非常有前景，对于肿瘤较小的乳腺癌患者队列，SLN阴性患者未行ALND的SLNB是腋窝分期的极佳方法。
