Leidenius M, Vaalavirta L, Heikkilä P, von Smitten K, Salmenkivi K
Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland.
J Surg Oncol. 2008 Jul 1;98(1):21-6. doi: 10.1002/jso.21085.
Our aim was to investigate the prevalence of and risk factors for having four or more positive axillary lymph nodes among breast cancer patients undergoing sentinel node (SN) biopsy.
Between February 2005 and July 2007, 1,062 breast cancer patients with the clinical tumour size not larger than 3 cm underwent SN biopsy and axillary clearance (AC), when SN was positive. These patients were identified in a prospectively collected database.
Four or more positive axillary nodes were detected in 68 patients representing 6% of the entire study population and 16% of the 436 node positive cases. Features regarded as predictive for a very low risk included (1) T1a or T1b tumours, (2) grade I tumours, (3) tumours with a favourable subtype, that is mucinous, tubular or medullary breast cancer, (4) no nodal macrometastases and (5) SN ratio lower than 0.5.
Only few patients with T1a-b tumours or grade 1 tumours, as well as those with minimal involvement of the sentinel nodes have four or more positive axillary lymph nodes. However, these risk factors can be definitely assessed only after surgery, decreasing their value in the clinical decision making.
我们的目的是调查在接受前哨淋巴结（SN）活检的乳腺癌患者中，腋窝淋巴结有四个或更多转移阳性的发生率及危险因素。
2005年2月至2007年7月期间，1062例临床肿瘤大小不超过3cm的乳腺癌患者接受了SN活检及腋窝清扫术（AC，当SN为阳性时）。这些患者来自一个前瞻性收集的数据库。
68例患者检测到腋窝淋巴结有四个或更多转移阳性，占整个研究人群的6%，占436例淋巴结阳性病例的16%。被视为极低风险预测因素的特征包括：（1）T1a或T1b期肿瘤；（2）I级肿瘤；（3）具有良好亚型的肿瘤，即黏液性、管状或髓样乳腺癌；（4）无淋巴结大分子转移；（5）SN比值低于0.5。
只有少数T1a-b期肿瘤或I级肿瘤患者以及前哨淋巴结受累最少的患者腋窝淋巴结有四个或更多转移阳性。然而，这些危险因素只有在手术后才能明确评估，这降低了它们在临床决策中的价值。
