Medical Oncology Department, Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain.
Ann Surg Oncol. 2010 Mar;17(3):772-7. doi: 10.1245/s10434-009-0804-y.
The need for axillary lymph node dissection (ALND) in breast cancer patients with sentinel lymph node (SLN) micrometastases remains controversial. The aims of the study were to evaluate the locoregional failure and outcome of breast cancer patients with sentinel node micrometastases who did not undergo completion ALND.
Between November 2000 and December 2006, SLN biopsy was successfully performed in 1178 patients with invasive breast carcinoma. Only patients with macrometastasis (>2 mm) underwent ALND, while patients with negative SLN or micrometastases did not undergo further treatment of the axilla, by either surgery or radiotherapy. Regarding adjuvant therapy decision, patients with SLN-micrometastases (pN1(mi)) were considered as node-positive patients.
Of 1,178 patients, 59 (5%) had micrometastases. Of those with micrometastases, 14 (24%) underwent ALND because the intraoperative study of the SLN yielded a positive result. With a median follow-up of 60 (range, 8-94) months, none of the patients with SLN micrometastases in whom ALND was omitted developed an axillary recurrence, while one patient in whom ALND was performed developed infraclavicular lymph node recurrence. One patient, who declined postoperative breast irradiation, developed breast recurrence and distant metastasis.
Breast cancer patients with SLN micrometastases in whom ALND was omitted had a very low locoregional failure rate. This study supports the theory that ALND might be avoided in these patients, providing that adjuvant systemic treatment equal to treatment provided to treat node-positive disease is administered. However, longer follow-up and results of additional prospective studies are needed.
对于前哨淋巴结（SLN）微转移的乳腺癌患者是否需要行腋窝淋巴结清扫术（ALND）仍存在争议。本研究旨在评估未行完成性 ALND 的 SLN 微转移乳腺癌患者的局部区域复发和结局。
2000 年 11 月至 2006 年 12 月，成功对 1178 例浸润性乳腺癌患者进行了 SLN 活检。仅对 SLN 有宏转移（>2mm）的患者行 ALND，而 SLN 阴性或微转移的患者则不行腋窝进一步治疗，包括手术或放疗。对于辅助治疗决策，SLN 微转移（pN1（mi））的患者被视为阳性淋巴结患者。
在 1178 例患者中，59 例（5%）有微转移。在这些微转移患者中，14 例（24%）因 SLN 术中检查结果阳性而行 ALND。中位随访时间为 60 个月（范围，8-94 个月），在未行 ALND 的 SLN 微转移患者中，无一例发生腋窝复发，而行 ALND 的患者中发生锁骨下淋巴结复发 1 例。1 例拒绝行术后乳房放疗的患者发生乳房复发和远处转移。
未行 ALND 的 SLN 微转移乳腺癌患者局部区域复发率非常低。本研究支持以下理论，即在给予与治疗阳性淋巴结疾病相同的辅助全身治疗的情况下，可避免对这些患者行 ALND。但是，需要更长时间的随访和更多的前瞻性研究结果。
