Lumachi Franco, Borsato Simonetta, Tregnaghi Alberto, Ferretti Guido, Povolato Michele, Cecchin Diego, Marzola Maria Cristina, Zucchetta Pietro, Bui Franco, Fassina Ambrogio
University of Padua, School of Medicine, Breast Surgery Unit, Department of Surgical and Gastroenterological Sciences, via Giustiniani 2, 35128 Padova, Italy.
Anticancer Res. 2009 Feb;29(2):491-4.
Intraoperative analysis of the sentinel lymph node (SLN) status is currently performed in patients with breast cancer (BC) undergoing surgery. Axillary node (AN) metastases are present in up to 60% of cases, but the risk is only 30% in patients with early stage (T1) BC. The aim of this study was to evaluate the usefulness of 99mTc-sestamibi scintimammography (SSM), axillary ultrasonography (US) and US-guided fine-needle aspiration (FNA) cytology together in detecting axillary metastases preoperatively and their potential role in reducing the number of SLN procedures.
A series of 86 consecutive women (median age 57 years, range 30-72) with confirmed BC and clinically negative nodes (T1N0) underwent both SSM and US prior to surgery. US-guided FNA cytology was performed in all the patients with suspicious AN on US, or positive SSM and ultrasonographically visualized enlarged nodes.
Final pathology showed 4 pT1bN0, 1 pT1bN1, 60 pT1cN0 and 21 pT1cN1 BC. The sensitivity, specificity, and accuracy were 59.1%, 93.7% and 84.9% for SSM, 63.6%, 90.6% and 83.7% for US, and 72.7%, 97.8% and 90.7% for SSM and US together. Using FNA cytology the specificity reached 100%, but the sensitivity did not increase. A combined method using radioisotope and blue dye was used for SLN biopsy. The procedure was omitted in patients with FNA cytology showing AN metastases (N = 14, 16.3%) and they underwent level I-II axillary dissection, as well as those with positive SLN biopsy on frozen section (8 out of 72, 11.1%).
In patients with BC, preoperatively selected by SSM and US in whom US-guided axillary FNA cytology has shown the presence of AN metastases, the SLN biopsy can be avoided and AN dissection should be the primary procedure.
目前，在接受手术的乳腺癌（BC）患者中会进行前哨淋巴结（SLN）状态的术中分析。腋窝淋巴结（AN）转移在高达60%的病例中存在，但在早期（T1）BC患者中风险仅为30%。本研究的目的是评估99mTc-甲氧基异丁基异腈闪烁乳腺造影（SSM）、腋窝超声检查（US）和US引导下细针穿刺抽吸（FNA）细胞学检查联合应用在术前检测腋窝转移中的作用及其在减少SLN手术数量方面的潜在作用。
连续86例确诊为BC且临床淋巴结阴性（T1N0）的女性（中位年龄57岁，范围30 - 72岁）在手术前接受了SSM和US检查。对所有US检查发现可疑AN、SSM阳性且超声可见肿大淋巴结的患者进行了US引导下FNA细胞学检查。
最终病理显示4例pT1bN0、1例pT1bN1、60例pT1cN0和21例pT1cN1 BC。SSM的敏感性、特异性和准确性分别为59.1%、93.7%和84.9%，US分别为63.6%、90.6%和83.7%，SSM和US联合应用分别为72.7%、97.8%和90.7%。使用FNA细胞学检查特异性达到100%，但敏感性未增加。采用放射性同位素和蓝色染料联合方法进行SLN活检。FNA细胞学检查显示AN转移的患者（N = 14，16.3%）以及冰冻切片SLN活检阳性的患者（72例中的8例，11.1%）未进行该操作，而是接受了I - II级腋窝清扫。
在经SSM和US术前筛选且US引导下腋窝FNA细胞学检查显示存在AN转移的BC患者中，可以避免SLN活检，应将AN清扫作为主要手术方式。
