Knauer Michael, Konstantiniuk Peter, Haid Anton, Wenzl Etienne, Riegler-Keil Michaela, Pöstlberger Sabine, Reitsamer Roland, Schrenk Peter
Department of Surgery, General Hospital, Feldkirch, Austria.
J Clin Oncol. 2006 Jul 20;24(21):3374-80. doi: 10.1200/JCO.2006.05.7372.
Multicentric breast cancer has been considered to be a contraindication for sentinel node (SN) biopsy (SNB). In this prospective multi-institutional trial, SNB-feasibility and accuracy was evaluated in 142 patients with multicentric cancer from the Austrian Sentinel Node Study Group (ASNSG) and compared with data from 3,216 patients with unicentric cancer.
Between 1996 and 2004, 3,730 patients underwent SNB at 15 ASNSG-affiliated hospitals. Patient data were entered in a multicenter database. One hundred forty-two patients presented with multicentric invasive breast cancer and underwent SNB.
Intraoperatively, a mean number of 1.67 SNs were excised (identification-rate, 91.5%). The incidence of SN metastases was 60.8% (79 of 130). This was confirmed by axillary lymph node dissection (ALND) in 125 patients. Of patients with positive SNs, 60.8% (48 of 79) showed involvement of nonsentinel nodes (NSNs), as did three patients with negative SNs (false-negative rate, 4.0). Sensitivity, negative predictive value, and overall accuracy were 96.0%, 93.3%, and 97.3%, respectively. Ninety-one percent of the patients underwent mastectomy, and 9% were treated with breast conserving surgery. None of the patients have shown axillary recurrence so far (mean follow-up, 28.8 months). Compared with 3,216 patients with unicentric cancer, there was a significantly higher rate of SN metastases as well as in NSNs, whereas there was no difference in detection and false-negative rates.
Multicentric breast cancer is a new indication for SNB without routine ALND in controlled trials. Given adequate quality control and an interdisciplinary teamwork of surgical, nuclear medicine, and pathology units, SNB is both feasible and accurate in this disease entity.
多中心乳腺癌一直被视为前哨淋巴结活检（SNB）的禁忌证。在这项前瞻性多机构试验中，奥地利前哨淋巴结研究组（ASNSG）对142例多中心癌症患者的SNB可行性及准确性进行了评估，并与3216例单中心癌症患者的数据进行了比较。
1996年至2004年间，15家隶属于ASNSG的医院对3730例患者进行了SNB。患者数据录入多中心数据库。142例多中心浸润性乳腺癌患者接受了SNB。
术中平均切除前哨淋巴结1.67枚（识别率91.5%）。前哨淋巴结转移发生率为60.8%（130例中的79例）。125例患者通过腋窝淋巴结清扫（ALND）得以证实。在前哨淋巴结阳性的患者中，60.8%（79例中的48例）出现非前哨淋巴结受累，3例前哨淋巴结阴性患者也出现非前哨淋巴结受累（假阴性率4.0）。敏感性、阴性预测值和总体准确率分别为96.0%、93.3%和97.3%。91%的患者接受了乳房切除术，9%接受了保乳手术。目前尚无患者出现腋窝复发（平均随访28.8个月）。与3216例单中心癌症患者相比，前哨淋巴结及非前哨淋巴结转移率显著更高，而检测率和假阴性率无差异。
在对照试验中，多中心乳腺癌是无需常规腋窝淋巴结清扫的SNB新适应证。鉴于有足够的质量控制以及外科、核医学和病理科单位的跨学科团队合作，SNB在这种疾病实体中既可行又准确。
