Vrdoljak Danko Velimir, Ramljak Vesna, Muzina Dubravka, Sarceviç Bozena, Knezević Fabijan, Juzbasić Stjepan
Department of Surgical Oncology, University Hospital for Tumors, Zagreb, Croatia.
Tumori. 2005 Mar-Apr;91(2):177-81. doi: 10.1177/030089160509100214.
This study was aimed at analyzing metastatic involvement in interpectoral (Rotter's) lymph nodes in relation to tumor location, size, grade and hormone receptor status in primary breast cancer.
The study included 172 female patients undergoing surgery for breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to August 2003. In addition to the standard surgical procedure, interpectoral (Rotter's) lymph nodes were removed in all of the patients. Serum levels of the tumor marker CA 15-3 were determined before surgery and hormone receptor status after surgery.
Rotter's lymph nodes were identified in 67% of the patients, with metastatic involvement being found in 20% of the Rotter's nodes. Metastatic involvement of Rotter's nodes in patients with negative and positive axillary lymph nodes was 4% and 35%, respectively. When we looked at the location of the tumor in patients with metastatic involvement of Rotter's nodes, we found that tumors located in the upper quadrants were more prone to metastasis to Rotter's nodes; there was a significant positive correlation between tumor location and positive Rotter's nodes (r = 0.953, P = 0.012). As regards tumor size, Rotter's nodes were identified in 15%, 20% and 30% of stage T1 (< 2 cm), T2 (2-5 cm) and T3 (> 5 cm) tumors, respectively. Hormone receptor status showed no statistically significant difference in the expression of estrogen and progesterone receptors between patients with and those without positive Rotter's nodes. Of 35 Rotter's node-positive patients, 31.4% had elevated serum levels of CA 15-3; the level was significantly higher in Rotter's-positive patients compared to those with negative (or absent) Rotter's nodes.
The results show that one-fifth of breast cancer patients, or even one-third of those with positive axillary lymph nodes, are discharged with positive interpectoral lymph nodes that remain undiagnosed. As the nodes can be surgically removed without additional mutilation, exploration of Rotter's lymph nodes should be introduced into routine clinical practice.
本研究旨在分析原发性乳腺癌患者胸肌间（Rotter）淋巴结转移情况与肿瘤位置、大小、分级及激素受体状态之间的关系。
本研究纳入了2001年11月至2003年8月期间在克罗地亚萨格勒布肿瘤大学医院接受乳腺癌手术的172例女性患者。除了标准手术操作外，所有患者均切除了胸肌间（Rotter）淋巴结。术前测定肿瘤标志物CA 15 - 3的血清水平，术后测定激素受体状态。
67%的患者发现有Rotter淋巴结，其中20%的Rotter淋巴结有转移。腋窝淋巴结阴性和阳性患者中Rotter淋巴结转移率分别为4%和35%。观察有Rotter淋巴结转移患者的肿瘤位置时，发现位于上象限的肿瘤更容易转移至Rotter淋巴结；肿瘤位置与Rotter淋巴结阳性之间存在显著正相关（r = 0.953，P = 0.012）。关于肿瘤大小，T1期（< 2 cm）、T2期（2 - 5 cm）和T3期（> 5 cm）肿瘤中分别有15%、20%和30%发现有Rotter淋巴结。激素受体状态显示，Rotter淋巴结阳性和阴性患者之间雌激素和孕激素受体表达无统计学显著差异。在35例Rotter淋巴结阳性患者中，31.4%的患者血清CA 15 - 3水平升高；Rotter淋巴结阳性患者的该水平显著高于Rotter淋巴结阴性（或无Rotter淋巴结）患者。
结果表明，五分之一的乳腺癌患者，甚至三分之一腋窝淋巴结阳性的患者，术后胸肌间淋巴结阳性但未被诊断出来。由于这些淋巴结可通过手术切除且无需额外的致残性操作，因此应将Rotter淋巴结探查引入常规临床实践。
