Changsri Channikarn, Prakash Sonam, Sandweiss Lynn, Bose Shikha
Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
Breast J. 2004 Sep-Oct;10(5):392-7. doi: 10.1111/j.1075-122X.2004.21446.x.
Sentinel lymphadenectomy is a sensitive and specific procedure that has reduced the need for complete axillary lymph node dissections in patients with negative sentinel lymph nodes (SLNs). However, numerous studies have shown that SLN may be the only positive lymph node in 40 to 70% of cases. This study was therefore undertaken to determine if the characteristics of primary breast tumor or its metastasis in the SLN could predict the presence of residual disease in the nonsentinel lymph nodes (NSLNs) and thus allow for further reduction in axillary lymph node surgery. The SLN procedure was performed on 329 patients at our institution, of which 131 had positive SLNs and underwent further axillary surgery. Fifty-four patients had additional disease in the NSLNs, while in the remaining 77 cases, no residual disease was detected. The clinical and pathologic features of these cases were reviewed and statistical analysis was performed. Multivariate analysis determined two significant independent variables for prediction of residual disease in the axilla: the size of the metastatic tumor in SLNs and the presence of its extranodal extension. The mean tumor size in SLNs without residual disease in NSLNs was 0.4 cm. It was 1.1 cm in patients with additional NSLN metastasis. The positive predictive value in both instances is about 80%. The risk of NSLN involvement in patients with SLN tumors of < or = 0.4 cm was 21%. The risk was the same (21%) for patients with micrometastatic disease (< or = 0.2 cm) in SLNs. In these cases the residual disease in the NSLNs was also small. SLNs with metastatic deposits larger than 1.0 cm were likely to contain additional metastases in the NSLNs in 81% of cases. This increased to 100% if the primary carcinoma was larger than 5 cm, if it was poorly differentiated, or if it showed HER-2/neu gene amplification. The presence of an extranodal extension of SLN metastasis was an independent predictor of residual axillary disease and was associated with NSLN metastasis in 76% of cases. Primary tumor characteristics did not correlate with the incidence of NSLN metastasis in our series.
前哨淋巴结切除术是一种敏感且特异的手术方法，已减少了前哨淋巴结（SLN）阴性患者进行腋窝淋巴结清扫术的必要性。然而，大量研究表明，在40%至70%的病例中，SLN可能是唯一的阳性淋巴结。因此，本研究旨在确定原发性乳腺肿瘤或其在SLN中的转移特征是否能够预测非前哨淋巴结（NSLN）中是否存在残留疾病，从而进一步减少腋窝淋巴结手术。我们机构对329例患者进行了SLN手术，其中131例SLN阳性并接受了进一步的腋窝手术。54例患者的NSLN有额外病变，而其余77例未检测到残留疾病。对这些病例的临床和病理特征进行了回顾并进行了统计分析。多因素分析确定了两个预测腋窝残留疾病的显著独立变量：SLN中转移瘤的大小及其结外扩展情况。NSLN无残留疾病的患者，其SLN中的平均肿瘤大小为0.4 cm。NSLN有额外转移的患者，其SLN中的平均肿瘤大小为1.1 cm。两种情况下的阳性预测值均约为80%。SLN肿瘤≤0.4 cm的患者，NSLN受累风险为21%。SLN有微转移（≤0.2 cm）的患者，其风险相同（21%）。在这些病例中，NSLN中的残留疾病也较少。转移灶大于1.0 cm的SLN，在NSLN中可能有额外转移的比例为81%。如果原发性癌大于5 cm、分化差或显示HER-2/neu基因扩增，这一比例将增至100%。SLN转移的结外扩展是腋窝残留疾病的独立预测因素，76%的病例与NSLN转移相关。在我们的系列研究中，原发性肿瘤特征与NSLN转移发生率无关。
