Parmar V, Hawaldar R, Nadkarni M S, Badwe R A
Department of Surgical Oncology, Tata Memorial Hospital, Ernest Borges Road, Parel, Mumbai, Maharashtra 400012, India.
Natl Med J India. 2009 Sep-Oct;22(5):234-6.
Targeted sentinel node biopsy has been extensively validated. It has been incorporated into standard guidelines for axillary prediction in women with clinically node-negative operable breast cancer. However, the high cost of the gamma probe and the need for radiocolloid have limited its widespread acceptance in developing countries. We aimed to validate low axillary sampling as a reliable alternative method to sentinel node biopsy in a developing country.
An anatomically guided low axillary sampling removes the lower level I axillary fat with lymph nodes and the method was validated by completing axillary clearance in all women.
Three hundred fifty-five women with clinically node-negative operable breast cancer underwent validation of low axillary sampling, with lymph nodes identified in all of them. The median number of nodes identified in low axillary sampling was 5 with overall node-positivity of 32.1% (114 of 355). Ten of these 114 patients were wrongly identified as node-negative by the sampled lymph nodes, i.e. a false-negative rate of 8.8%. Further exploratory analysis showed that 6-node low axillary sampling gave an excellent false-negative rate of 1.5% with 95% sensitivity, which was comparable with the highly targeted sentinel node biopsy technique.
With an overall false-negative rate of 8.8% with 5-node low axillary sampling, and even better false-negative rate of 1.5% with 6-node low axillary sampling, axillary sampling is a low-cost technology, which is a reliable alternative to sentinel node biopsy for axillary nodal prediction in clinically node-negative breast cancer.
靶向前哨淋巴结活检已得到广泛验证。它已被纳入临床腋窝淋巴结阴性的可手术乳腺癌女性腋窝评估的标准指南。然而，γ 探测仪的高成本以及对放射性胶体的需求限制了其在发展中国家的广泛应用。我们旨在验证低位腋窝取样作为发展中国家前哨淋巴结活检的一种可靠替代方法。
解剖学引导下的低位腋窝取样是切除 I 级低位腋窝脂肪及淋巴结，该方法通过对所有女性完成腋窝清扫来进行验证。
355 例临床腋窝淋巴结阴性的可手术乳腺癌女性接受了低位腋窝取样验证，所有患者均发现有淋巴结。低位腋窝取样中发现的淋巴结中位数为 5 个，总体淋巴结阳性率为 32.1%（355 例中的 114 例）。这 114 例患者中有 10 例被取样的淋巴结错误判定为淋巴结阴性，即假阴性率为 8.8%。进一步的探索性分析表明，6 枚淋巴结的低位腋窝取样假阴性率极佳，为 1.5%，敏感性为 95%，与高度靶向的前哨淋巴结活检技术相当。
5 枚淋巴结的低位腋窝取样总体假阴性率为 8.8%，6 枚淋巴结的低位腋窝取样假阴性率甚至更低，为 1.5%，腋窝取样是一种低成本技术，是临床腋窝淋巴结阴性乳腺癌腋窝淋巴结评估中前哨淋巴结活检的可靠替代方法。
