Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Surg Oncol. 2010 Oct 1;102(5):404-7. doi: 10.1002/jso.21466.
The study aim was to investigate our institutional strategies for axillary staging in breast cancer patients undergoing neoadjuvant therapy.
We identified 595 patients treated with neoadjuvant therapy between 2000 and 2007. Axillary staging occurred by four methods: (1) pre-therapy fine needle aspiration biopsy (FNAB); (2) pre-therapy sentinel lymph node biopsy (SLNB); (3) post-therapy SLNB; or (4) post-therapy axillary lymph node dissection (ALND).
Of 595 patients, 115 underwent FNAB (Group 1; 36 N0, 79 N+), 88 underwent SLNB pre-therapy (Group 2; 47 N0, 41 N+), 55 underwent SLNB post-therapy (Group 3; 42 N0, 13 N+), and 337 underwent ALND post-therapy (Group 4; 133 N0, 204 N+). There was no difference between groups according to patient age, race, stage of disease, estrogen/progesterone receptor and Her-2neu status, or type of neoadjuvant therapy.
The lack of standardized recommendations for axillary staging in the setting of neoadjuvant therapy leads to variable approaches within an institution. The use of ALND without pre-therapy axillary assessment may result in over-treatment of patients. Randomized clinical trials are needed to determine the feasibility and accuracy of SLNB following neoadjuvant therapy. Until such data are available, pre-therapy axillary staging may reduce the number of unnecessary lymph node dissections.
本研究旨在探讨我们在接受新辅助治疗的乳腺癌患者中行腋窝分期的机构策略。
我们确定了 2000 年至 2007 年间接受新辅助治疗的 595 例患者。腋窝分期采用以下四种方法：（1）治疗前细针抽吸活检（FNAB）；（2）治疗前前哨淋巴结活检（SLNB）；（3）治疗后 SLNB；或（4）治疗后腋窝淋巴结清扫术（ALND）。
在 595 例患者中，115 例行 FNAB（组 1；36 例 N0，79 例 N+），88 例行 SLNB 术前（组 2；47 例 N0，41 例 N+），55 例行 SLNB 术后（组 3；42 例 N0，13 例 N+），337 例行 ALND 术后（组 4；133 例 N0，204 例 N+）。组间患者年龄、种族、疾病分期、雌激素/孕激素受体和 Her-2neu 状态以及新辅助治疗类型无差异。
新辅助治疗中缺乏腋窝分期的标准化推荐意见导致机构内治疗方法存在差异。不进行术前腋窝评估而使用 ALND 可能导致过度治疗患者。需要进行随机临床试验来确定新辅助治疗后 SLNB 的可行性和准确性。在获得这些数据之前，术前腋窝分期可能会减少不必要的淋巴结清扫术数量。
