Marrazzo Antonio, Taormina Pietra, Gebbiab Vittorio, David Massimo, Riili Ignazio, Lo Gerfo Domenico, Casà Luigi, Noto Antonio
Department of Experimental Oncology and Clinical Application, University of Palermo, Palermo.
Chir Ital. 2007 Sep-Oct;59(5):693-9.
Today evaluation of axillary involvement can be routinely performed with the technique of sentinel lymph node biopsy (SLNB). One of the greatest advantages of SLNB is the nearly total absence of local postoperative complications. It is important to understand whether SLNB is better than axillary lymph-node dissection (ALND) for staging axillary nodal involvement. The aim of the study was to evaluate the axillary staging accuracy comparing three different methods: axillary dissection, sentinel node biopsy with the traditional 4-6 sections and sentinel node biopsy with complete analysis of the lymph node. 527 consecutive patients (525 females and 2 males) with invasive breast cancer < or = 3 cm and clinically negative axillary nodes were divided into 3 different groups: group A treated with axillary dissection, group B treated with sentinel nodal biopsy analysed with 4-6 sections, and group C treated with sentinel node biopsy with analysis of the entire node. All patients underwent a quadrantectomy to treat the tumor. Group differences and statistical significance were assessed by ANOVA. The percentages of N+ in group A and group B were 25.80% and 28% respectively, while in the third group it rose to 45%, or almost half the patients. The differences among the three groups were statistically significant (p = 0.02). From our analysis of the data it emerges that axillary dissection and sentinel node biopsy with analysis of 4-6 sections have the same accuracy in staging the nodal status of the axilla; analysis of the entire sentinel lymph node revealed an increased number of patients with axillary nodal involvement, proving more powerful in predicting nodal stage. SLNB with complete examination of the SLN removed can be considered the best method for axillary staging in breast cancer patients with clinical negative nodes. In our study, the percentage of metastases encountered after complete examination of SLN was 45% compared to the accuracy of axillary dissection that was only 25.8%. Moreover, this approach avoids the useless axillary cleaning in about 55-60% of cases, decreasing postoperative morbidity and mortality.
如今，可通过前哨淋巴结活检（SLNB）技术常规评估腋窝受累情况。SLNB最大的优势之一是术后局部并发症几乎完全不存在。了解SLNB在腋窝淋巴结受累分期方面是否优于腋窝淋巴结清扫术（ALND）很重要。本研究的目的是比较三种不同方法评估腋窝分期的准确性：腋窝清扫术、传统4 - 6切片的前哨淋巴结活检以及对淋巴结进行完整分析的前哨淋巴结活检。527例连续的浸润性乳腺癌≤3cm且临床腋窝淋巴结阴性的患者（525例女性和2例男性）被分为3个不同组：A组接受腋窝清扫术，B组接受前哨淋巴结活检并进行4 - 6切片分析，C组接受前哨淋巴结活检并对整个淋巴结进行分析。所有患者均接受象限切除术治疗肿瘤。通过方差分析评估组间差异和统计学意义。A组和B组N + 的百分比分别为25.80%和28%，而在第三组中升至45%，即几乎一半的患者。三组之间的差异具有统计学意义（p = 0.02）。从我们对数据的分析可以看出，腋窝清扫术和进行4 - 6切片分析的前哨淋巴结活检在腋窝淋巴结状态分期方面具有相同的准确性；对整个前哨淋巴结的分析显示腋窝淋巴结受累患者数量增加，在预测淋巴结分期方面更具优势。对切除的前哨淋巴结进行完整检查的SLNB可被认为是临床腋窝淋巴结阴性的乳腺癌患者腋窝分期的最佳方法。在我们的研究中，对前哨淋巴结进行完整检查后发现转移的百分比为45%，而腋窝清扫术的准确性仅为25.8%。此外，这种方法可避免约55 - 60%的病例进行无用的腋窝清扫，降低术后发病率和死亡率。
