van Deurzen Carolien H M, de Boer Maaike, Monninkhof Evelyn M, Bult Peter, van der Wall Elsken, Tjan-Heijnen Vivianne C G, van Diest Paul J
Department of Pathology, University Medical Center Utrecht, GA Utrecht, The Netherlands.
J Natl Cancer Inst. 2008 Nov 19;100(22):1574-80. doi: 10.1093/jnci/djn343. Epub 2008 Nov 11.
There are many reports on the frequency of non-sentinel lymph node involvement when isolated tumor cells are found in the sentinel node, but results and recommendations for the use of an axillary lymph node dissection differ among studies. This systematic review was conducted to give an overview of this issue and to provide recommendations for the use of an axillary lymph node dissection in these patients. We searched Medline, Embase, and Cochrane databases from January 1, 2002, through November 27, 2007, for articles on patients with invasive breast cancer who had isolated tumor cells in the sentinel lymph node (according to the sixth edition of the Cancer Staging Manual of the American Joint Committee on Cancer) and who also underwent axillary lymph node dissection. Of 411 selected articles, 29 (including 836 patients) were included in this review. These 29 studies were heterogeneous, reporting a wide range of non-sentinel lymph node involvement (defined as the presence of isolated tumor cells or micro- or macrometastases) associated with isolated tumor cells in the sentinel lymph node, with an overall pooled risk for such involvement of 12.3% (95% confidence interval = 9.5% to 15.7%). This pooled risk estimate was marginally higher than the risk of a false-negative sentinel lymph node biopsy examination (ie, 7%-8%) but marginally lower than the risk of non-sentinel lymph node metastases in patients with micrometastases (ie, approximately 20%) who are currently eligible for an axillary lymph node dissection. Because 36 (64%) of the 56 patients with isolated tumor cells in their sentinel lymph node also had non-sentinel lymph node macrometastases, those patients with isolated tumor cells in the sentinel lymph node without other indications for adjuvant systemic therapy might be candidates for axillary lymph node dissection.
关于前哨淋巴结中发现孤立肿瘤细胞时非前哨淋巴结受累频率的报道众多，但不同研究对于腋窝淋巴结清扫术应用的结果和建议存在差异。本系统评价旨在概述这一问题，并为这些患者腋窝淋巴结清扫术的应用提供建议。我们检索了2002年1月1日至2007年11月27日的Medline、Embase和Cochrane数据库，以查找有关浸润性乳腺癌患者的文章，这些患者在前哨淋巴结中存在孤立肿瘤细胞（根据美国癌症联合委员会癌症分期手册第六版）且接受了腋窝淋巴结清扫术。在411篇入选文章中，29篇（包括836例患者）纳入了本评价。这29项研究具有异质性，报道了与前哨淋巴结中孤立肿瘤细胞相关的广泛非前哨淋巴结受累情况（定义为存在孤立肿瘤细胞或微转移或宏转移），此类受累的总体合并风险为12.3%（95%置信区间 = 9.5%至15.7%）。该合并风险估计略高于前哨淋巴结活检假阴性的风险（即7%-8%），但略低于目前有资格接受腋窝淋巴结清扫术的微转移患者中非前哨淋巴结转移的风险（即约20%）。由于56例前哨淋巴结中有孤立肿瘤细胞的患者中有36例（64%）也存在非前哨淋巴结宏转移，那些前哨淋巴结中有孤立肿瘤细胞且无其他辅助全身治疗指征的患者可能是腋窝淋巴结清扫术的候选者。
