Fancellu Alessandro, Cottu Pierina, Feo Claudio F, Bertulu Daniele, Giuliani Giuliana, Mulas Silvia, Sanna Valeria, Mura Silvia, Madeddu Giuseppe, Spanu Angela
Clinical Surgery Unit, University of Sassari, Sassari, Italy.
Tumori. 2012 Jul-Aug;98(4):413-20. doi: 10.1177/030089161209800403.
The aims of this paper are to report the development of sentinel node biopsy (SNB) in breast cancer at a single institution and to discuss the relevant issues on SNB still to be elucidated.
From 1998 to 2010, 1021 SNBs with frozen section examination were carried out in patients with breast cancer. In the early period (1998-2002) SNB was always combined with axillary lymph node dissection (ALND). From 2002 onwards, only patients with a positive SNB result underwent ALND (late period). The characteristics of patients with infiltrating carcinoma (IC) and ductal carcinoma in situ (DCIS) and the histological status of the sentinel nodes were examined. The survival outcomes of node-negative patients were compared between patients submitted to SNB and ALND (ALND group) during the early period and patients who underwent only SNB during the late period (SNB group).
The sentinel node was identified intraoperatively in 98.3% of cases. During the early period the overall accuracy of SNB was 97.0%. During the late period, 700 patients with IC and 140 with DCIS underwent SNB. In the IC group, 149 patients (21.3%) had sentinel node macrometastases and 36 (5.1%) micrometastases; of that subgroup, 21 underwent ALND and no other metastatic lymph nodes were found, and 15 underwent SNB only. Axillary recurrences were observed in 4 patients (0.77%) with negative SNB; none of these were among the patients with micrometastatic SNB. Two patients (1.4%) with DCIS had a positive SNB. In node-negative patients the 5-year overall survival was 96.7% in the ALND group and 96.5% in the SNB group (P = 0.63). The 5-year disease-free survival was 93.8% and 93.2% in the ALND and SNB groups, respectively (P = 0.77).
Overall and disease-free survival in patients with a negative SNB result and no further axillary surgery were equal to those in patients with negative ALND. Intraoperative assessment of the sentinel node in expert hands has a low false-negative rate and allows immediate ALND in patients with sentinel node metastases, avoiding the need for a second operation. ALND for sentinel node micrometastases may be safely omitted in most patients with early stage breast cancer.
本文旨在报告一家机构中乳腺癌前哨淋巴结活检（SNB）的发展情况，并讨论SNB中仍有待阐明的相关问题。
1998年至2010年，对1021例乳腺癌患者进行了前哨淋巴结活检及冰冻切片检查。在早期（1998 - 2002年），SNB总是与腋窝淋巴结清扫术（ALND）联合进行。从2002年起，仅前哨淋巴结活检结果为阳性的患者接受ALND（后期）。检查浸润性癌（IC）和导管原位癌（DCIS）患者的特征以及前哨淋巴结的组织学状态。比较早期接受SNB和ALND的患者（ALND组）与后期仅接受SNB的患者（SNB组）中淋巴结阴性患者的生存结果。
98.3%的病例术中识别出前哨淋巴结。早期SNB的总体准确率为97.0%。后期，700例IC患者和140例DCIS患者接受了SNB。在IC组中，149例患者（21.3%）有前哨淋巴结大转移，36例（5.1%）有微转移；在该亚组中，21例接受了ALND，未发现其他转移淋巴结，15例仅接受了SNB。前哨淋巴结活检阴性的4例患者（0.77%）出现腋窝复发；这些患者中没有微转移前哨淋巴结的患者。2例（1.4%）DCIS患者前哨淋巴结活检阳性。在淋巴结阴性患者中，ALND组的5年总生存率为96.7%，SNB组为96.5%（P = 0.63）。ALND组和SNB组的5年无病生存率分别为93.8%和93.2%（P = 0.77）。
前哨淋巴结活检结果为阴性且未进行进一步腋窝手术的患者的总生存率和无病生存率与腋窝淋巴结清扫阴性的患者相当。在专家手中，术中对前哨淋巴结的评估假阴性率低，对于前哨淋巴结转移的患者可立即进行ALND，避免了二次手术的需要。对于大多数早期乳腺癌患者，可安全地省略对前哨淋巴结微转移的ALND。
