Povoski Stephen P, Young Donn C, Walker Michael J, Carson William E, Yee Lisa D, Agnese Doreen M, Farrar William B
Section of Surgical Oncology of the Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA.
World J Surg Oncol. 2007 Feb 9;5:18. doi: 10.1186/1477-7819-5-18.
Although sentinel lymph node (SLN) biopsy is a standard of care for the evaluation of the axillary lymph nodes during breast cancer surgery, a substantial degree of variation exists among individual surgeons as to what represents an adequate assessment. The aim of the current study was to assess when metastatic disease was first identified within consecutively harvested SLN candidates for invasive breast cancers demonstrating a positive SLN.
We retrospectively analyzed a series of 400 breast cancers from a recently published prospective randomized clinical trial. A combined radiocolloid and blue dye technique was used. All potential SLN candidates, containing counts of at least 10% of the hottest SLN and/or containing blue dye, were harvested and were consecutively numbered in the order of the decreasing level of counts (with the hottest SLN representing SLN #1).
Among 371 invasive breast cancers, a SLN was identified within 353 cases (95%). Mean number of SLNs identified was 2.5 (range, 1 to 9), with a single SLN identified in 104 (29%) cases, two identified in 110 (31%), three identified in 73 (21%), four identified in 35 (10%), five identified in 16 (5%), and six or more identified in 15 (4%). A positive SLN was found in 104 (29%) cases. SLN #1 was the first positive SLN in 86 (83%). SLN #2 was the first positive SLN in 15 (14%). SLN #3, SLN #4, and SLN #5 were the first positive SLN in one case (1%) each. A positive SLN was found in 18% (19/104) of cases when a single SLN was identified, as compared to in 34% (85/249) when two or more SLNs were identified (P = 0.003).
The accurate and optimal assessment of the axilla during breast cancer surgery requires persistence and diligence for attempting to identify all potential SLN candidates in order to avoid failing to recognize a positive SLN. The scenario in which only a single negative SLN candidate is intraoperatively identified is one that should raise some concern to the operating surgeon.
尽管前哨淋巴结（SLN）活检是乳腺癌手术中评估腋窝淋巴结的标准治疗方法，但在什么是充分评估方面，各个外科医生之间存在很大差异。本研究的目的是评估在连续采集的浸润性乳腺癌SLN候选者中，何时首次发现转移性疾病，这些候选者的SLN呈阳性。
我们回顾性分析了最近发表的一项前瞻性随机临床试验中的400例乳腺癌。采用放射性胶体和蓝色染料联合技术。所有潜在的SLN候选者，其计数至少为最热点SLN的10%和/或含有蓝色染料，均被采集，并按照计数水平从高到低的顺序连续编号（最热点SLN为SLN #1）。
在371例浸润性乳腺癌中，353例（95%）发现了SLN。发现的SLN平均数量为2.5个（范围为1至9个），其中1个SLN的有104例（29%），2个的有110例（31%），3个的有73例（21%），4个的有35例（10%），5个的有16例（5%），6个或更多的有15例（4%）。104例（29%）发现SLN呈阳性。SLN #1是86例（83%）中的首个阳性SLN。SLN #2是15例（14%）中的首个阳性SLN。SLN #3、SLN #4和SLN #5分别在1例（1%）中是首个阳性SLN。发现单个SLN时，18%（19/104）的病例SLN呈阳性，而发现两个或更多SLN时，这一比例为34%（85/249）（P = 0.003）。
乳腺癌手术中对腋窝进行准确和最佳评估需要坚持和勤勉，以试图识别所有潜在的SLN候选者，从而避免未能识别出阳性SLN。术中仅识别出单个阴性SLN候选者的情况应引起手术医生的一些关注。
