Shen Jeannie, Gilcrease Michael Z, Babiera Gildy V, Ross Merrick I, Meric-Bernstam Funda, Feig Barry W, Kuerer Henry M, Francis Ashleigh, Ames Frederick C, Hunt Kelly K
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2007 Apr 1;109(7):1255-63. doi: 10.1002/cncr.22540.
The feasibility and accuracy of sentinel lymph node (SLN) biopsy in patients with breast cancer after preoperative chemotherapy has been demonstrated in a number of large, single-institution studies. However, a relative contraindication to SLN biopsy after preoperative chemotherapy is the presence of axillary metastases at initial diagnosis. The objective of this study was to determine the feasibility and accuracy of SLN biopsy after preoperative chemotherapy in patients with documented axillary metastases at presentation.
Between 1994 and 2002, 69 patients who had axillary metastases identified by ultrasound-guided, fine-needle aspiration underwent SLN biopsy after treatment on prospective, preoperative chemotherapy protocols. All but 8 patients underwent axillary lymph node dissection (ALND). Those 8 patients either declined additional surgery or were offered enrollment in other institutional protocols.
The median patient age was 49 years, and the median primary tumor size was 4 cm. The SLN identification rate was 92.8%. Thirty-one of 64 patients (48.4%) had successfully mapped, positive SLNs. Sixty-one patients underwent ALND, including 5 patients who did not have an SLN identified. In the 56 patients in whom a SLN was identified and an ALND was performed, 10 patients had a false-negative SLN (25%).
SLN biopsy was feasible after preoperative chemotherapy, even in patients who initially presented with cytologically proven, lymph node-positive disease. However, the false-negative rate of SLN biopsy in this group of patients was much higher than that observed in clinically lymph node-negative patients. Based on the current results, the status of the SLN cannot be used as a reliable indicator of the presence or absence of residual disease in the axilla in this patient population.
多项大型单机构研究已证实前哨淋巴结（SLN）活检在接受术前化疗的乳腺癌患者中的可行性和准确性。然而，术前化疗后SLN活检的一个相对禁忌证是初始诊断时存在腋窝转移。本研究的目的是确定术前化疗后对初诊时有腋窝转移记录的患者进行SLN活检的可行性和准确性。
1994年至2002年期间，69例经超声引导细针穿刺确定有腋窝转移的患者在接受前瞻性术前化疗方案治疗后接受了SLN活检。除8例患者外，所有患者均接受了腋窝淋巴结清扫术（ALND）。这8例患者要么拒绝进一步手术，要么被纳入其他机构方案。
患者中位年龄为49岁，原发肿瘤中位大小为4cm。SLN识别率为92.8%。64例患者中有31例（48.4%）成功定位到阳性SLN。61例患者接受了ALND，其中5例未识别出SLN。在56例识别出SLN并进行了ALND的患者中，10例患者的SLN为假阴性（25%）。
术前化疗后SLN活检是可行的，即使是最初表现为细胞学证实的淋巴结阳性疾病的患者。然而，这组患者中SLN活检的假阴性率远高于临床淋巴结阴性患者。根据目前的结果，在该患者群体中，SLN的状态不能用作腋窝是否存在残留疾病的可靠指标。
