Viale Giuseppe, Maiorano Eugenio, Pruneri Giancarlo, Mastropasqua Mauro G, Valentini Stefano, Galimberti Viviana, Zurrida Stefano, Maisonneuve Patrick, Paganelli Giovanni, Mazzarol Giovanni
Department of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy.
Ann Surg. 2005 Feb;241(2):319-25. doi: 10.1097/01.sla.0000150255.30665.52.
To assess whether the risk for nonsentinel node metastases may be predicted, thus sparing a subgroup of patients with breast carcinoma and a positive sentinel lymph node (SLN) biopsy completion axillary lymph node dissection (ALND).
The SLN is the only involved axillary lymph node in the majority of the patients undergoing ALND for a positive SLN biopsy. A model to predict the status of nonsentinel axillary lymph nodes could help tailor surgical therapy to those patients most likely to benefit from completion ALND.
All the axillary sentinel and nonsentinel lymph nodes of 1228 patients were reviewed histologically and reclassified according to the current TNM classification of malignant tumors as bearing isolated tumor cells only, micrometastases, or (macro)metastases. The prevalence of metastases in nonsentinel lymph nodes was correlated to the type of SLN involvement and the size of the metastasis, the number of affected SLNs, and the prospectively collected clinicopathologic variables of the primary tumors.
In multivariate analysis, further axillary involvement was significantly associated with the type and size of SLN metastases, the number of affected SLNs, and the occurrence of peritumoral vascular invasion in the primary tumor. A predictive model based on the characteristics most strongly associated with nonsentinel node metastases was able to identify subgroups of patients at significantly different risk for further axillary involvement.
Patients with the most favorable combination of predictive factors still have no less than 13% risk for nonsentinel lymph node metastases and should be offered completion ALND outside of clinical trials of SLN biopsy without back-up axillary clearing.
评估是否可以预测非前哨淋巴结转移的风险，从而使一部分乳腺癌且前哨淋巴结活检阳性的患者免于进行腋窝淋巴结清扫术（ALND）。
在大多数因前哨淋巴结活检阳性而接受ALND的患者中，前哨淋巴结是腋窝唯一受累的淋巴结。预测非前哨腋窝淋巴结状态的模型有助于为最有可能从完全性ALND中获益的患者量身定制手术治疗方案。
对1228例患者的所有腋窝前哨和非前哨淋巴结进行组织学检查，并根据当前恶性肿瘤的TNM分类重新分类为仅含有孤立肿瘤细胞、微转移或（宏）转移。非前哨淋巴结转移的发生率与前哨淋巴结受累类型、转移灶大小、受累前哨淋巴结数量以及原发肿瘤前瞻性收集的临床病理变量相关。
在多变量分析中，进一步的腋窝受累与前哨淋巴结转移的类型和大小、受累前哨淋巴结数量以及原发肿瘤瘤周血管侵犯的发生显著相关。基于与非前哨淋巴结转移最密切相关特征的预测模型能够识别出腋窝进一步受累风险差异显著的患者亚组。
具有最有利预测因素组合的患者非前哨淋巴结转移风险仍不少于13%，在无前哨淋巴结活检备用腋窝清扫的临床试验之外，应接受完全性ALND。
