H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Ann Surg Oncol. 2010 Feb;17(2):552-7. doi: 10.1245/s10434-009-0800-2.
Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) as the staging procedure for breast cancer. SLN biopsy causes less morbidity and is more cost effective than complete ALND. Lymphatic mapping and SLN biopsy have a low false-negative rate, but long-term outcomes in large consecutive series of patients are unavailable.
Retrospective review of a prospectively accrued institutional breast cancer database was performed. The initial mapping of 1,528 patients with invasive breast cancer that demonstrated negative sentinel node biopsy and no axillary dissection in 1,530 cases between January 1995 and June 2003 were collated and reviewed to achieve a long-term follow-up. These 1,528 patients were reviewed for follow-up time, local recurrences, distant metastases, and survival.
A total of 1,530 consecutively mapped invasive breast cancer cases had negative SLN biopsy and no ALND. The mean invasive tumor size of was 1.40 cm. Of patients, 1,212 (79.2%) underwent lumpectomy and 318 (20.8%) underwent mastectomy. Median follow-up was 63 months (range 0.1-144 months). There have been 4 (0.26%) cases presenting with local axillary recurrences, 54 (3.53%) cases presenting with local recurrences in the ipsilateral breast/chest wall, and 24 (1.57%) cases presenting with distant metastases.
These data confirm that SLN biopsy is an effective and safe alternative to ALND for detection of nodal metastases in patients with invasive breast cancer and validates its use as the standard tool for nodal staging.
前哨淋巴结(SLN)活检已取代腋窝淋巴结清扫术(ALND)成为乳腺癌的分期程序。SLN 活检的发病率较低,并且比完整的 ALND 更具成本效益。淋巴作图和 SLN 活检的假阴性率较低,但尚无大量连续患者的长期结果。
对前瞻性累积机构乳腺癌数据库进行回顾性审查。1995 年 1 月至 2003 年 6 月期间,对 1528 例浸润性乳腺癌患者进行了初始作图,在 1530 例患者中,SLN 活检和腋窝无解剖术均为阴性,对这些患者进行了整理和回顾,以实现长期随访。对这 1528 例患者进行了随访时间、局部复发、远处转移和生存情况的回顾。
共有 1530 例连续作图的浸润性乳腺癌患者的 SLN 活检为阴性,且无 ALND。浸润性肿瘤的平均大小为 1.40 厘米。其中 1212 例(79.2%)患者接受了保乳手术,318 例(20.8%)患者接受了乳房切除术。中位随访时间为 63 个月(范围 0.1-144 个月)。有 4 例(0.26%)患者出现局部腋窝复发,54 例(3.53%)患者同侧乳房/胸壁出现局部复发,24 例(1.57%)患者出现远处转移。
这些数据证实,SLN 活检是一种有效的替代方法,可以替代 ALND 检测浸润性乳腺癌患者的淋巴结转移,验证了其作为淋巴结分期标准工具的使用。