Khan Amina, Sabel Michael S, Nees Alexis, Diehl Kathleen M, Cimmino Vincent M, Kleer Celina G, Schott Anne F, Hayes Dan F, Chang Alfred E, Newman Lisa A
Department of Surgery, Comprehensive Cancer Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109, USA.
Ann Surg Oncol. 2005 Sep;12(9):697-704. doi: 10.1245/ASO.2005.09.007. Epub 2005 Aug 4.
There is ongoing debate regarding the optimal sequence of sentinel lymph node (SLN) biopsy and neoadjuvant chemotherapy (CTX) for breast cancer. We report the accuracy of comprehensive pre-neoadjuvant CTX and post-neoadjuvant CTX axillary staging via ultrasound imaging, fine-needle aspiration (FNA) biopsy, and SLN biopsy.
From 2001 to 2004, 91 neoadjuvant CTX patients at the University of Michigan Comprehensive Cancer Center underwent axillary staging by ultrasonography, ultrasound-guided FNA biopsy, SLN biopsy, or a combination of these.
Axillary staging was pathologically negative by pre-neoadjuvant CTX SLN biopsy in 53 cases (58%); these patients had no further axillary surgery. In 38 cases (42%), axillary metastases were confirmed at presentation by either ultrasound-guided FNA or SLN biopsy. These 38 patients underwent completion axillary lymph node dissection (ALND) after delivery of neoadjuvant CTX. Follow-up lymphatic mapping was attempted in 33 of these cases, and the SLN was identified in 32 (identification rate, 97%). One third of these cases were completely node negative on ALND. Residual metastatic disease was identified in 22 cases, and the SLN was falsely negative in 1 (4.5%).
Patients receiving neoadjuvant CTX can have accurate axillary nodal staging by ultrasound-guided FNA or SLN biopsy. In cases of documented axillary metastasis at presentation, repeat axillary staging with SLN biopsy can document the post-neoadjuvant CTX nodal status. This strategy optimizes pre-neoadjuvant CTX and post-neoadjuvant CTX staging information by distinguishing the patients who are node negative at presentation from those who have been downstaged to node negativity and offers the potential for avoiding unnecessary ALNDs in both of these patient subsets.
关于乳腺癌前哨淋巴结（SLN）活检和新辅助化疗（CTX）的最佳顺序存在持续争论。我们报告了通过超声成像、细针穿刺（FNA）活检和SLN活检进行新辅助化疗前和新辅助化疗后腋窝分期的准确性。
2001年至2004年，密歇根大学综合癌症中心的91例接受新辅助化疗的患者通过超声检查、超声引导下FNA活检、SLN活检或这些方法的组合进行腋窝分期。
新辅助化疗前SLN活检病理显示腋窝分期阴性的有53例（58%）；这些患者未进行进一步的腋窝手术。38例（42%）患者在新辅助化疗前通过超声引导下FNA或SLN活检确诊有腋窝转移。这38例患者在接受新辅助化疗后进行了腋窝淋巴结清扫术（ALND）。其中33例尝试进行了随访淋巴管造影，32例（识别率97%）找到了SLN。这些病例中有三分之一在ALND时完全无淋巴结转移。22例发现有残留转移病灶，1例（4.5%）SLN出现假阴性。
接受新辅助化疗的患者可通过超声引导下FNA或SLN活检准确进行腋窝淋巴结分期。对于新辅助化疗前已记录有腋窝转移的病例，重复进行SLN活检进行腋窝分期可明确新辅助化疗后的淋巴结状态。该策略通过区分新辅助化疗前淋巴结阴性的患者和已降期至淋巴结阴性的患者，优化了新辅助化疗前和新辅助化疗后的分期信息，并有可能避免这两类患者亚组中不必要的ALND。
