乳腺癌前哨淋巴结肿瘤负荷对第二级淋巴结转移的预测价值。
Predictive value of tumor load in breast cancer sentinel lymph nodes for second echelon lymph node metastases.
作者信息
van Deurzen C H M, van Hillegersberg R, Hobbelink M G G, Seldenrijk C A, Koelemij R, van Diest P J
机构信息
Department of Pathology, University Medical Center Utrecht, The Netherlands.
出版信息
Cell Oncol. 2007;29(6):497-505. doi: 10.1155/2007/570683.
BACKGROUND
The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND.
METHODS
A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement.
RESULTS
Second echelon metastases were found in 116/317 cases (36.6%). Frequency of second echelon lymph node involvement in patients with isolated tumor cells (ITC, N=23), micro- (N=101) and macrometastases (N=193) was 13%, 20% and 48%, respectively (p<0.001). Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size </=1 cm (N=12, 3.8%) had second echelon lymph node involvement.
CONCLUSIONS
Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND.
背景
浸润性乳腺癌且前哨淋巴结（SN）转移灶较小的患者是否需要常规腋窝淋巴结清扫（ALND）仍存在疑问。准确预测二级淋巴结转移可识别出最可能从ALND中获益的患者。
方法
回顾性分析317例浸润性乳腺癌且腋窝SN肿瘤阳性并接受了ALND的患者。评估原发肿瘤和SN的临床病理特征，作为二级淋巴结转移的可能预测因素。
结果
317例患者中有116例（36.6%）出现二级转移。孤立肿瘤细胞（ITC，N = 23）、微小转移（N = 101）和宏转移（N = 193）患者的二级淋巴结转移频率分别为13%、20%和48%（p < 0.001）。基于肿瘤占据SN的面积百分比，无法选出二级淋巴结转移率低于20%的患者亚组。然而，SN为ITC或微小转移且原发肿瘤大小≤1 cm的患者无一例发生二级淋巴结转移（N = 12，3.8%）。
结论
准确测量的SN肿瘤负荷可预测二级淋巴结转移。然而，即使是ITC患者，仍有13%发生二级淋巴结转移，这表明ALND是合理的。
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