Mustać Elvira, Matusan-Ilijas Koviljka, Marijić Blazen, Smokvina Miljenko, Jonjić Nives
Department of Pathology, School of Medicine, University of Rijeka, University Department of Nuclear Medicine, Rijeka University Hospital Center, Rijeka, Croatia.
Int J Surg Pathol. 2010 Feb;18(1):36-41. doi: 10.1177/1066896909332113. Epub 2009 May 15.
Axillary lymph node dissection (ALND) is an important procedure in the staging of breast cancer patients. However, it is associated with a significant morbidity rate. In addition, using early diagnosis a high number of cases with negative lymph nodes can be identified. A lymph node defined as sentinel lymph node (SLN) would be the first to receive tumoral drainage. A less morbid but accurate staining procedure using mapping and SLN biopsy has been introduced. The aim of this study was to estimate the likelihood of additional disease in the axilla after SLN analysis. A total of 259 breast carcinomas and SLN biopsies followed by ALND were examined. The patient median age was 59 years, approximately 75% of them postmenopausal. Tumor size was 1.4 +/- 0.8 cm (almost 80% in pT1). SLNs were positive in 59 of 259 (22.8%) carcinomas, 30 (11.6%) with micrometastases (<2.0 mm) and 29 (11.2%) with metastases. Tumor size ( P = .004) and presence of lymphovascular invasion (LVI; P = .034) were found to be significant predictors of pathologically positive SLN. Following ALND, positive non-SLNs were present mostly in patients with metastasis >2 mm in SLN (P = .003), in carcinoma with higher nuclear grade ( P = .044), decreased estrogen receptor (ER; P = .042), and progesterone receptor (PR; P = .042). Finally, lymph node status (pN) following SLN and ALND was found to be significantly associated with tumor size ( P = .006), LVI (P = .037), PR (P = .023), and Her-2 status (P < .001). These results point to detailed analysis of primary tumor and SLN that may increase the precision of patient selection for further axillary surgery or radiotherapy.
腋窝淋巴结清扫术（ALND）是乳腺癌患者分期中的一项重要手术。然而，它与较高的发病率相关。此外，通过早期诊断可识别出大量淋巴结阴性的病例。前哨淋巴结（SLN）被定义为最先接受肿瘤引流的淋巴结。现已引入一种使用定位和SLN活检的发病率较低但准确的染色程序。本研究的目的是评估SLN分析后腋窝出现额外疾病的可能性。共检查了259例乳腺癌及随后进行ALND的SLN活检病例。患者的中位年龄为59岁，其中约75%为绝经后女性。肿瘤大小为1.4±0.8 cm（pT1期患者几乎占80%）。259例癌中有59例（22.8%）的SLN呈阳性，其中30例（11.6%）为微转移（<2.0 mm），29例（11.2%）为转移。发现肿瘤大小（P = .004）和淋巴管浸润（LVI；P = .034）是病理阳性SLN的重要预测因素。ALND后，非SLN阳性主要出现在SLN转移>2 mm的患者中（P = .003）、核分级较高的癌中（P = .044）、雌激素受体（ER；P = .042）和孕激素受体（PR；P = .042）降低的患者中。最后，发现SLN和ALND后的淋巴结状态（pN）与肿瘤大小（P = .006）、LVI（P = .037）、PR（P = .023）和Her-2状态（P < .001）显著相关。这些结果表明对原发肿瘤和SLN进行详细分析可能会提高进一步腋窝手术或放疗患者选择的准确性。
