Olszewski Wojciech P, Szumera-Ciećkiewicz Anna, Piechocki Jacek, Towpik Edward, Olszewski Włodzimierz T
Department of Pathology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw.
Pol J Pathol. 2009;60(3):138-43.
Lymph node metastases are the most significant prognostic factors in patients with breast carcinoma. A positive sentinel lymph node (SLN) biopsy is followed by an axillary lymph node (ALN) dissection. In sentinel lymph node negative cases the risk of positive non-sentinel ALN is very low though not absent. The aim of this study was to determine predictive factors for non-sentinel lymph node metastases on the basis of sentinel lymph node metastasis characteristics as well as features of the primary tumour.
128 patients who had a positive SLN biopsy for breast carcinoma in 2005-2007 were identified. The breast carcinoma metastases in each SLN were assessed according to their location within the node (subcapsular, mixed subcapsular and parenchymal, parenchymal, multifocal or extensive) and metastatic infiltration of perinodal tissue was also reported. These data were correlated with the ALN involvement and characteristics of the primary tumour.
The strong predictors of the ALN metastasis included the SLN metastasis diameter (7.6 vs. 4.4 mm) and size classified according to WHO classification (ITC 0 vs. 100%, micrometastasis 23.5 vs. 76.5%, macrometastasis 51.9 vs. 48.1%). The SLN metastases with a diameter of above 3 mm were associated with approximately twice more frequent ALN metastases. In an extensive location of SLN metastasis the highest percentage of ALN metastases was found (65 vs. 35%). The weak predictors of ALN metastases were: primary tumor diameter (> 2 cm), immunohistochemical HER2 positive status, infiltration of sentinel perinodal tissue by metastasis, histological primary tumour grade.
Some additional details, which can be easily evaluated in a routine SLN examination in breast carcinoma, have a predictive value of the ALN metastatic status and should be included in the histopathological report.
淋巴结转移是乳腺癌患者最重要的预后因素。前哨淋巴结（SLN）活检呈阳性后需进行腋窝淋巴结（ALN）清扫。在前哨淋巴结阴性的病例中，非前哨ALN阳性的风险很低，尽管并非不存在。本研究的目的是根据前哨淋巴结转移特征以及原发肿瘤的特征来确定非前哨淋巴结转移的预测因素。
确定了2005年至2007年期间128例前哨淋巴结活检呈阳性的乳腺癌患者。根据每个前哨淋巴结内转移灶的位置（被膜下、被膜下与实质混合、实质、多灶性或广泛性）评估乳腺癌转移情况，并报告淋巴结周围组织的转移浸润情况。这些数据与腋窝淋巴结受累情况及原发肿瘤的特征相关。
腋窝淋巴结转移的强预测因素包括前哨淋巴结转移直径（7.6对4.4毫米）以及根据世界卫生组织分类法分类的大小（原位癌0对100%，微转移23.5对76.5%，宏转移51.9对48.1%）。直径大于3毫米的前哨淋巴结转移与腋窝淋巴结转移频率大约高出两倍相关。在前哨淋巴结转移广泛的情况下，腋窝淋巴结转移的比例最高（65对35%）。腋窝淋巴结转移的弱预测因素为：原发肿瘤直径（>2厘米）、免疫组化HER2阳性状态、转移灶对前哨淋巴结周围组织的浸润、原发肿瘤组织学分级。
一些可在乳腺癌常规前哨淋巴结检查中轻松评估的额外细节，对腋窝淋巴结转移状态具有预测价值，应纳入组织病理学报告中。
