Lanng C, Hoffmann J, Galatius H, Engel U
Breast Surgery Clinic, Horsholm Hospital, Usserod Kongevej 102, DK-2970 Horsholm, Denmark.
Eur J Surg Oncol. 2007 Apr;33(3):281-4. doi: 10.1016/j.ejso.2006.09.032. Epub 2006 Nov 3.
Clinically palpable lymph nodes (LNs) are regarded as a contraindication for performing the sentinel node (SN) procedure. Many studies have shown, however, that clinical assessment of axillary LNs is inaccurate. This study evaluated the reliability of clinical axillary LN assessment by experts and assessed whether inaccuracy can be related to LN size.
Three hundred and one consecutive breast cancer patients undergoing either axillary dissection or SN were studied prospectively.
The risk of having metastasis to the LN was 40.4% if the preoperative clinical assessment was "non-palpable LN", 61.5% if the assessment was "palpable but benign LN" and 84.4% if it was "suspicious LN". There were no clinically significant differences in mean size either when the LN was palpable versus non-palpable, or when the LN had metastasis or not.
The clinical assessment of axillary LNs as a criterion for offering the SN procedure is of little value.
临床上可触及的淋巴结（LNs）被视为进行前哨淋巴结（SN）手术的禁忌症。然而，许多研究表明，腋窝淋巴结的临床评估并不准确。本研究评估了专家对腋窝淋巴结进行临床评估的可靠性，并评估了评估不准确是否与淋巴结大小有关。
对301例连续接受腋窝清扫或前哨淋巴结活检的乳腺癌患者进行前瞻性研究。
如果术前临床评估为“不可触及淋巴结”，淋巴结转移风险为40.4%；如果评估为“可触及但良性淋巴结”，转移风险为61.5%；如果评估为“可疑淋巴结”，转移风险为84.4%。无论淋巴结是否可触及，或淋巴结有无转移，其平均大小均无临床显著差异。
将腋窝淋巴结的临床评估作为决定是否进行前哨淋巴结手术的标准，价值不大。
