Sianesi Mario, Del Rio Paolo, Martella Eugenia, De Notarpietro Fabiana, De Simone Belinda, Ghirarduzzi Andrea, Sianesi Nicoletta, Arcuri Maria Francesca
Ann Ital Chir. 2011 May-Jun;82(3):173-7.
The development of sentinel lymph node biopsy in breast cancer disease and the increasing of using adjuvant systemic therapy provide a rational reduction of axillary dissection in patients with Sentinel Lymph Nodes free from breast cancer cells. The aim of our study was to assess the state of the perisentinel lymph nodes removed and how these nodes can provide further information about the status of the axillary lymph nodes.
We have analysed data about 319 patients undergoing surgery for benign and malignant breast disease from January 2007 to July 2010; 134 cases were subjected to the sentinel lymph node biopsy; 29 cases of these patients had the presence of perisentinel lymph nodes at histological examination. Before the intervention, we have used colloidal albumin marked with 99mtc to select the sentinel lymph node; during the intervention, we identified by probe the ipercaptant lymph node, consequently we removed and sent it to histological extemporaneous definitive examination.
In 134 Sentinel Lymph Nodes examined, 15 resulted positive for breast cancer cells at extemporaneous examination. In these cases, we decided to proceed with an axillary dissection in the same operative session, with the discovery of axillary lymph nodes metastases in 3 cases on 15 (20%). The positive predictive value of sentinel lymph node in case of positivity was 0.2. 8 cases (6,7% of the lymph nodes sentinel biopsy made) were negative to extemporaneous examination and positive to definitive histological examination for presence of micrometastasis. In 8 axillary dissection, 3 patients were positive for the presence of metastasis. We have analysed with the test "t-student" these data divided on age and the value of Ki-67. Then we calculated the predictive positive and negative value (patients with negative sentinel lymph node: Mean age (+/- sd) =61.93 +/- 13.8 years, ki-67=10.87 +/- 5.78; patients with positive sentinel lymph node: Age mean (+/- sd) = 64 +/- 12 36 years, ki-67=14.08 +/- 8.005). The study showed no statistically significant differences between the positive and negative sentinel lymphnodes about the age (p=0.58) and the Ki-67 (p=0.184). In the 29 cases in which the sentinel lymph node was negative at extemporaneous histological examination and in which were removed the perisentinel lymph nodes, resulted negative at definitive histological examination, the negative predictive value was equal to 1.
The method of sentinel lymph node has demonstrated to be a reproducible, reliable and safe technique. The positivity of sentinel lymph node at final examination (micrometastasis, cells isolated) in case of extemporaneous examination negative for breast cancer cells, determines specifical considerations on surgical indication to axillary dissection. We think that in selected cases (age, biological characteristic of cancer) in which perisentinel lymph nodes were removed and free from breast cancer cells, may not be indicated in case of sentinel node positivity the axillary dissection.
前哨淋巴结活检在乳腺癌治疗中的发展以及辅助全身治疗应用的增加，为无乳腺癌细胞的前哨淋巴结患者合理减少腋窝清扫提供了依据。我们研究的目的是评估所切除的前哨淋巴结周围淋巴结的状态，以及这些淋巴结如何能提供有关腋窝淋巴结状态的更多信息。
我们分析了2007年1月至2010年7月期间319例接受乳腺良性和恶性疾病手术患者的数据；134例患者接受了前哨淋巴结活检；其中29例患者在组织学检查时发现存在前哨淋巴结周围淋巴结。在干预前，我们使用标记有99mtc的胶体白蛋白来选择前哨淋巴结；在干预过程中，我们通过探针识别出前哨淋巴结，随后将其切除并送去进行组织学即时最终检查。
在134个检查的前哨淋巴结中，15个在即时检查时发现有乳腺癌细胞阳性。在这些病例中，我们决定在同一手术过程中进行腋窝清扫，15例中有3例（20%）发现有腋窝淋巴结转移。前哨淋巴结阳性时的阳性预测值为0.2。8例（占所做前哨淋巴结活检的6.7%）即时检查为阴性，但最终组织学检查因存在微转移而呈阳性。在8例腋窝清扫中，3例患者有转移阳性。我们用“t检验”分析了按年龄和Ki-67值划分的这些数据。然后我们计算了预测阳性和阴性值（前哨淋巴结阴性的患者：平均年龄（±标准差）=61.93±13.8岁，Ki-67=10.87±5.78；前哨淋巴结阳性的患者：平均年龄（±标准差）=64±12.36岁，Ki-67=14.08±8.005）。研究表明，前哨淋巴结阳性和阴性在年龄（p=0.58）和Ki-67（p=0.184）方面无统计学显著差异。在29例前哨淋巴结即时组织学检查为阴性且切除了前哨淋巴结周围淋巴结、最终组织学检查也为阴性的病例中，阴性预测值等于1。
前哨淋巴结方法已证明是一种可重复、可靠且安全的技术。在即时检查乳腺癌细胞为阴性的情况下，最终检查（微转移、孤立细胞）前哨淋巴结呈阳性，决定了对腋窝清扫手术指征的特殊考虑。我们认为，在某些选定的病例（年龄、癌症的生物学特征）中，切除了前哨淋巴结周围淋巴结且无乳腺癌细胞，在前哨淋巴结阳性的情况下可能不适合进行腋窝清扫。
