Török Klára, Péley Gábor, Mátrai Zoltán, Bidlek Mária, Szabó Eva, Sinkovics István, Polgár Csaba, Farkas Emil, Orosz Zsolt, Köves István
Országos Onkológiai Intézet, Altalános-és Mellkassebészeti Osztály.
Magy Seb. 2006 Jun;59(3):173-8.
The clinical significance of sentinel lymph node biopsy for staging patients with ductal carcinoma in situ has not yet been solved. Determining the role of this method for the treatment of in situ ductal carcinoma has been the aim of this study.
Dual agent guided sentinel lymph node biopsy with preoperative lymphoscintigraphy was performed on 36 patients with breast ductal carcinoma in situ from January 2001 to March 2004 at the Department of General and Thoracic Surgery, National Institute of Oncology, Budapest. Completion axillary lymph node dissection was not performed routinely. The sentinel lymph nodes were histologically examined at 0.5-1 mm levels with routine hematoxylin and eosin staining.
One patient has been excluded from the final analysis because of contralateral invasive breast cancer and simultaneous local recurrence in her medical history. Micro- or submicrometastases were found in 2 patients. If our patient number is completed with the 5 patients operated on for ductal carcinoma in situ during the period of our feasibility study (from December 1997 to March 2000) then the rate of patients with positive sentinel lymph node(s) will be 5% (2/40). All metastases were less than 2 mm in size. Metastases were found only in patients with high risk, extended ductal carcinoma in situ who finally underwent mastectomy. Completion axillary lymphadenectomy has not been performed even for patients with positive sentinel lymph node and no regional recurrence has yet been observed.
Our results corresponds well to the international ones. Performing sentinel lymph node biopsy for ductal carcinoma in situ of the breast is not recommended on the basis of the international and our own experiences. Sentinel lymph node biopsy is essential for patients undergoing mastectomy. In other cases when preoperative diagnostic studies do not verify invasion unequivocally we advise to perform sentinel lymph node biopsy (if necessary) after the final histological result of the excised breast specimen.
前哨淋巴结活检对导管原位癌患者进行分期的临床意义尚未明确。确定该方法在导管原位癌治疗中的作用是本研究的目的。
2001年1月至2004年3月，在布达佩斯国家肿瘤研究所普通胸外科，对36例乳腺导管原位癌患者进行了术前淋巴闪烁显像引导的双剂前哨淋巴结活检。未常规进行腋窝淋巴结清扫术。前哨淋巴结采用苏木精和伊红常规染色，在0.5 - 1毫米水平进行组织学检查。
1例患者因对侧浸润性乳腺癌及同时存在局部复发被排除在最终分析之外。2例患者发现微转移或亚微转移。如果将可行性研究期间（1997年12月至2000年3月）接受导管原位癌手术的5例患者纳入我们的患者数量，则前哨淋巴结阳性患者的比例为5%（2/40）。所有转移灶均小于2毫米。转移仅在最终接受乳房切除术的高危、广泛导管原位癌患者中发现。即使前哨淋巴结阳性的患者也未进行腋窝淋巴结清扫术，且尚未观察到区域复发。
我们的结果与国际结果相符。基于国际经验和我们自己的经验，不建议对乳腺导管原位癌进行前哨淋巴结活检。前哨淋巴结活检对接受乳房切除术的患者至关重要。在其他情况下，若术前诊断研究不能明确证实浸润，我们建议在切除乳房标本的最终组织学结果出来后（如有必要）进行前哨淋巴结活检。
