Yi Min, Meric-Bernstam Funda, Ross Merrick I, Akins Jeri S, Hwang Rosa F, Lucci Anthony, Kuerer Henry M, Babiera Gildy V, Gilcrease Michael Z, Hunt Kelly K
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Cancer. 2008 Jul 1;113(1):30-7. doi: 10.1002/cncr.23514.
: It remains unclear how many sentinel lymph nodes (SLNs) must be removed to accurately predict lymph node status during SLN dissection in breast cancer. The objective of this study was to determine how many SLNs need to be removed for accurate lymph node staging and which patient and tumor characteristics influence this number.
: The authors reviewed data for all patients in their prospective database with clinical tumor, lymph node, metastasis (TNM) T1 through T3, N0, M0 breast cancer who underwent lymphatic mapping at their institution during the years 1994 through 2006. There were 777 patients who had at least 1 SLN that was positive for cancer. Simple and multiple quantile regression analyses were used to determine which patient and tumor characteristics were associated with the number of positive SLNs. The baseline number of SLNs that needed to be dissected for detection of 99% of positive SLNs in the total group of patients also was determined.
: The mean number of SLNs removed in the 777 lymph node-positive patients was 2.9 (range, 1-13 SLNs). Greater than 99% of positive SLNs were identified in the first 5 lymph nodes removed. On univariate analysis, tumor histology, patient race, tumor location, and tumor size significantly affected the number of SLNs that needed to be removed to identify 99% of all positive SLNs. On multivariate analysis, mixed ductal and lobular histology, Caucasian race, inner quadrant tumor location, and T1 tumor classification significantly increased the number of SLNs that needed to be removed to achieve 99% recovery of all positive SLNs.
: In general, the removal of a maximum of 5 SLNs at surgery allowed for the recovery of >99% of positive SLNs in patients with breast cancer. The current findings indicated that tumor histology, patient race, and tumor size and location may influence this number.
在乳腺癌前哨淋巴结清扫术中，尚不清楚必须切除多少个前哨淋巴结（SLN）才能准确预测淋巴结状态。本研究的目的是确定需要切除多少个SLN才能进行准确的淋巴结分期，以及哪些患者和肿瘤特征会影响这个数量。
作者回顾了其前瞻性数据库中1994年至2006年期间在其机构接受淋巴绘图的所有临床肿瘤、淋巴结、转移（TNM）分期为T1至T3、N0、M0乳腺癌患者的数据。有777例患者至少有1个SLN呈癌症阳性。采用简单和多元分位数回归分析来确定哪些患者和肿瘤特征与阳性SLN的数量相关。还确定了在所有患者组中检测到99%的阳性SLN所需切除的SLN基线数量。
777例淋巴结阳性患者切除的SLN平均数量为2.9个（范围为1至13个SLN）。在前5个切除的淋巴结中识别出了超过99%的阳性SLN。单因素分析显示，肿瘤组织学、患者种族、肿瘤位置和肿瘤大小显著影响为识别99%的所有阳性SLN而需要切除的SLN数量。多因素分析显示，混合导管和小叶组织学、白种人种族、内象限肿瘤位置和T1肿瘤分类显著增加了为实现99%的所有阳性SLN回收率而需要切除的SLN数量。
一般来说，手术中最多切除5个SLN可使乳腺癌患者中>99%的阳性SLN被检出。目前的研究结果表明，肿瘤组织学、患者种族以及肿瘤大小和位置可能会影响这个数量。
