Breast and Surgical Oncology at The Poche Centre, 40 Rocklands Rd, North Sydney, NSW 2060, Australia.
Eur J Surg Oncol. 2011 May;37(5):371-85. doi: 10.1016/j.ejso.2011.01.011. Epub 2011 Feb 3.
While sentinel lymph node biopsy (SLNB) is established in the management of small unifocal breast cancer its role in management of multifocal (MF), multicentric (MC) and larger tumors is still evolving.
Medline was searched; studies meeting pre-determined criteria were included. Data were extracted and entered into evidence tables.
Twenty six studies met inclusion criteria and reported data on accuracy; no randomized trials were identified. For MF cancers (n = 314 cases), success rate for identification of an SLN was 86-94%, SLN positivity rate 42-59%, false negative rate (FNR) 0-33% and overall accuracy 78-100%. For MC (n = 294 cases): success rate 92-100%, SLN positivity rate 25-61%, FNR 4-8% and accuracy 96-100%. For 'multiple breast cancer' (studies combining MF/MC cases; n = 996 cases): success rate 92-100%, SLN positivity rate 12-63%, FNR 0-25%, and accuracy 82-100%. For larger tumors (n = 1912 cases): success rate 86-100%, SLN positivity rate 49-77%, FNR 3-18% and accuracy 85-98%. For MC/MF and larger cancers overall non-SLN positivity rates were up to 82%; axillary recurrence rates were low but seldom reported.
There are no randomized trials evaluating the safety of SLNB in MF/MC and larger breast cancers. Based on limited evidence, success rate and FNR appear to be similar to those for small unifocal cancers, however node positivity rates are higher and rates of non-SLN positivity are very high. Awareness of these issues is essential when recommending SLNB based axillary management for these higher-risk tumors.
虽然前哨淋巴结活检 (SLNB) 在小的单一乳腺癌的管理中已确立，但在多灶性 (MF)、多中心 (MC) 和更大肿瘤的管理中的作用仍在不断发展。
检索 Medline；纳入符合预先确定标准的研究。提取数据并输入证据表。
26 项研究符合纳入标准，并报告了准确性数据；未确定随机试验。对于 MF 癌症 (n = 314 例)，识别 SLN 的成功率为 86-94%，SLN 阳性率为 42-59%，假阴性率 (FNR) 为 0-33%，总准确率为 78-100%。对于 MC (n = 294 例)：成功率为 92-100%，SLN 阳性率为 25-61%，FNR 为 4-8%，准确率为 96-100%。对于“多发性乳腺癌”(结合 MF/MC 病例的研究；n = 996 例)：成功率为 92-100%，SLN 阳性率为 12-63%，FNR 为 0-25%，准确率为 82-100%。对于更大的肿瘤 (n = 1912 例)：成功率为 86-100%，SLN 阳性率为 49-77%，FNR 为 3-18%，准确率为 85-98%。对于 MC/MF 和更大的癌症，非 SLN 阳性率高达 82%；腋窝复发率较低，但很少报道。
没有随机试验评估 SLNB 在 MF/MC 和更大乳腺癌中的安全性。基于有限的证据，成功率和 FNR 似乎与小的单一癌症相似，但淋巴结阳性率更高，非 SLN 阳性率非常高。在为这些高风险肿瘤推荐基于 SLNB 的腋窝管理时，必须了解这些问题。
