García-Vilanova Comas A, García Vilanova A, Fuster-Diana E, Martínez-Alzamora N, Fernández-Tena Jm, García-Vilanova Comas J, García-Vilanova Comas M
Department of Surgery, Surgical Oncology Unit, Valencia University General Hospital, Spain.
Clin Transl Oncol. 2006 Feb;8(2):108-18. doi: 10.1007/s12094-006-0167-9.
The indication and extent of axillary lymph node dissection in breast cancer remains open to controversy.
In this context, a 20-year survival study has been made of 1600 breast cancer patients subjected during surgical treatment to systematic dissection of the acromiothoracic vascular pedicle together with the accompanying lymph nodes (Rotter and Grossman interpectoral lymph node groups). An anatomical study of these nodes was also conducted in 100 necropsies, with the evaluation of 200 acromiothoracic vascular pedicles.
The interpectoral lymph nodes were anatomically present in 42% of the necropsies and in 35.1% of the patients subjected to surgery. The prognosis was much worse in cases of neoplastic infiltration of the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence of other prognostic factors.
In view of the results obtained, the designation of grade N3 of the TNM classification is proposed for malignancies with positive interpectoral lymph node infiltration.
乳腺癌腋窝淋巴结清扫的指征和范围仍存在争议。
在此背景下，对1600例乳腺癌患者进行了为期20年的生存研究，这些患者在手术治疗期间接受了肩胸血管蒂及其伴随淋巴结（Rotter和格罗斯曼胸肌间淋巴结组）的系统性清扫。还对100例尸检中的这些淋巴结进行了解剖学研究，评估了200个肩胸血管蒂。
胸肌间淋巴结在42%的尸检和35.1%的手术患者中解剖学上存在。胸肌间淋巴结发生肿瘤浸润时预后更差（Kaplan-Meier生存研究），无论其他预后因素的影响如何。
鉴于所获得的结果，建议对胸肌间淋巴结浸润阳性的恶性肿瘤采用TNM分类的N3级。
