Le Bouëdec G, de Lapasse C, Mishellany F, Chêne G, Michy T, Gimbergues P, Dauplat J
Service de chirurgie, centre Jean-Perrin (centre de lutte contre le cancer d'Auvergne), 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 01, France.
Gynecol Obstet Fertil. 2007 Apr;35(4):317-22. doi: 10.1016/j.gyobfe.2006.12.024. Epub 2007 Mar 6.
To investigate the role of sentinel lymph node biopsy for microinvasive ductal carcinoma in situ of the breast.
From January 2001 to January 2006, lymphatic mapping was performed using radiocolloid and/or blue dye technique. Full axillary lymph node dissection was accomplished systematically in 10 instances at the beginning of the study, and furthermore when the sentinel node was involved (macrometastatic or micrometastatic disease).
Identification rate was 98% (40/41), the unsuccessful procedure occurred after incisional biopsy for diagnosis. The number of sentinel nodes removed was 2 in average (1-5). Sentinel node involvement was found in 10% of cases (4/40): 1 sentinel node macrometastasis pN1, 2 sentinel node micrometastases determined by hematoxylin and eosin staining pN1 (mi), 1 sentinel node micrometastasis detected only by immunohistochemical staining pN0 (mi).
Sentinel lymph node sampling should not be currently applied for management of every ductal carcinoma in situ of the breast but a selective utilization is proposed in documented high risk subset of patients according to clinical, mammographic, and histologic features obtained by percutaneous biopsies. Ductal carcinoma in situ (DCIS) with proved or suspected microinvasion could be scheduled for sentinel node procedure a fortiori in cases undergoing mastectomy because of extensive DCIS before the occurrence of disturbances of lymphatic drainage induced by surgical breast dissection.
探讨前哨淋巴结活检在乳腺微浸润导管原位癌中的作用。
2001年1月至2006年1月，采用放射性胶体和/或蓝色染料技术进行淋巴绘图。在研究开始时，10例患者系统性地完成了腋窝淋巴结清扫，此外，当前哨淋巴结受累（存在大体转移或微转移疾病）时也进行清扫。
识别率为98%（40/41），诊断性切开活检后出现了1例不成功的操作。平均切除前哨淋巴结数量为2个（1 - 5个）。10%的病例（4/40）发现前哨淋巴结受累：1例前哨淋巴结大体转移为pN1，2例前哨淋巴结微转移通过苏木精和伊红染色确定为pN1（mi），1例前哨淋巴结微转移仅通过免疫组化染色检测到为pN0（mi）。
目前前哨淋巴结采样不应应用于乳腺导管原位癌的所有病例管理，而是建议根据经皮活检获得的临床、乳腺X线摄影和组织学特征，在记录的高风险患者亚组中进行选择性应用。对于已证实或疑似微浸润的导管原位癌（DCIS），由于广泛的DCIS在手术乳腺清扫引起淋巴引流紊乱之前进行乳房切除术的病例，更应安排前哨淋巴结手术。
