Amoui Mahasti, Akbari Mohammad Esmail, Tajeddini Araam, Nafisi Nahid, Raziei Ghasem, Modares Seyed Mahdi, Hashemi Mohammad
Cancer Research Center, Shohadae Tajrish Hospital, Nuclear Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Asian Pac J Cancer Prev. 2012;13(11):5385-9. doi: 10.7314/apjcp.2012.13.11.5385.
Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in node- negative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry.
Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery.
78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected.
SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.
前哨淋巴结活检（SLNB）是早期乳腺癌淋巴分期的一种精确方法。在有效的SLNB手术中，腋窝淋巴结清扫（ALND）可在淋巴结阴性的病例中省略，而不会影响患者安全。在本研究中，在没有任何连续切片或免疫组化的简单改良传统病理设施的情况下，评估了乳腺癌SLNB的检出率、准确性和假阴性率。
确诊为乳腺癌的患者纳入本研究。所有病例均进行SLNB和ALND。评估前哨淋巴结和通过ALND切除的淋巴结中的淋巴结转移情况，以确定假阴性率。仅通过改良传统技术进行3个切片的病理评估。检出率通过淋巴闪烁显像或手术期间确定。
对78例79个乳腺单位进行了评估。在淋巴闪烁显像中，79例中有75例（95%）检测到前哨淋巴结，手术期间79例中有76例（96%）检测到。在SLNB和ALND组中，75例中有30例（40%）检测到前哨淋巴结转移。SLNB方法检测淋巴结转移的准确性为92%。假阴性率为30例阳性病例中的3例：10%。在10例腋窝淋巴结肿大的病例中，7例检测到淋巴结转移。
对于各种肿瘤大小且无可触及淋巴结肿大的患者，推荐进行SLNB。在对前哨淋巴结进行改良传统病理检查时，至少可以检测到与ALND相似的大转移灶和一些微转移灶。因此，在切除所有可触及淋巴结的淋巴结阴性病例中，可以省略ALND。我们得出结论，SLNB作为乳腺癌手术中最重要的进展之一，即使在没有先进病理设施的地区也可以推广。
