Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Clin Breast Cancer. 2013 Apr;13(2):140-5. doi: 10.1016/j.clbc.2012.11.005. Epub 2012 Dec 5.
Current guidelines recommend full axillary lymph node dissection (ALND) whenever the SLN is positive for metastases. In our institute, we aim to complete surgery in a single setting and base the decision for ALND on the intraoperative FS analysis of the SLN. In this study, we evaluate the efficacy this practice in terms of the accuracy of FS analysis, patient recall rate, and additional time required for FS analysis.
Retrospective review was performed of 586 patients who underwent SLN biopsy at our institution from January 1, 2006 to December 31, 2010. Intraoperative FS analysis was routinely performed in all cases with a preoperative diagnosis of invasive breast cancer and in selected cases of ductal carcinoma in situ according to surgeon preference.
The SLN was positive for metastases in 123 (22.7%) patients; this was identified on FS analysis in 107 patients. FS analysis had a sensitivity of 87.0% and specificity of 100% and resulted in a patient recall rate of 3%. Micrometastasis accounted for most of the false negative FS results. These deposits were mostly detected only on deeper sectioning of the permanent sections of the SLN. An invasive lobular histology and lymphovascular invasion were found to be independent predictors of a false negative FS on multivariate analysis (P < .01). Intraoperative FS did not significantly prolong operating times.
Intraoperative FS analysis is an accurate and efficient means of rapid SLN assessment and allows ALND to be completed in a single setting.
目前的指南建议在 SLN 转移阳性时进行完整腋窝淋巴结清扫（ALND）。在我们的机构中，我们旨在在单次手术中完成手术，并根据 SLN 的术中 FS 分析来决定是否进行 ALND。在这项研究中，我们评估了这种实践在 FS 分析的准确性、患者召回率和 FS 分析所需的额外时间方面的效果。
对 2006 年 1 月 1 日至 2010 年 12 月 31 日期间在我们机构接受 SLN 活检的 586 名患者进行了回顾性研究。根据术前诊断为浸润性乳腺癌和外科医生的偏好，对所有病例和选定的导管原位癌病例均常规进行术中 FS 分析。
123 例（22.7%）患者的 SLN 转移阳性；其中 107 例通过 FS 分析确定。FS 分析的敏感性为 87.0%，特异性为 100%，患者召回率为 3%。微转移是 FS 分析假阴性结果的主要原因。这些沉积物大多仅在 SLN 的永久性切片的深层切片上才能检测到。多变量分析发现，浸润性小叶组织学和脉管侵犯是 FS 分析假阴性的独立预测因素（P <.01）。术中 FS 并未显著延长手术时间。
术中 FS 分析是一种快速评估 SLN 的准确有效的方法，可在单次手术中完成 ALND。
