Portsmouth Breast Care Centre, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
Surgeon. 2013 Oct;11(5):235-40. doi: 10.1016/j.surge.2012.12.008. Epub 2013 Feb 28.
Intra-operative sentinel node analysis (IOA) for breast cancer reduces the need for a second operation by revealing metastasis intra-operatively, allowing immediate axillary clearance. Critics argue that the number of patients deriving benefit is limited, as further surgery is often required for reasons other than nodal status.
To identify the proportion of women avoiding further surgery by using IOA excluding those who require further surgery for reasons other than axillary node metastasis.
All patients undergoing sentinel node biopsy with IOA over one year were reviewed. Patient demographics, margin positivity, sentinel node metastasis, requirement for further surgery, and cavity shave involvement were analysed.
322 patients were analysed: 253 undergoing breast-conserving surgery [BCS] and 69 undergoing mastectomy). IOA revealed metastasis in 81 (25.2.%) patients [25 undergoing mastectomy and 56 undergoing BCS], who underwent immediate axillary clearance. 43 BCS patients (17%) did not require further surgery other than for sentinel node involvement. 39 patients required further oncological surgery: 16 excision of margins; 13 completion mastectomy; 6 excision of margins followed by mastectomy; 3 completion axillary clearance; and 1 excision of recurrence. 20.6% had involvement of any circumferential histological margin. Cavity shaves were performed in 28.5% patients at initial surgery, the majority of which were clear of malignancy. 20 mastectomy patients had concordant definitive histology, avoiding a second operation. In total, 19.6% of this cohort avoided a second operation through the use of IOA.
Approximately 15% of patients undergoing breast conservation surgery for breast cancer require further surgery. However, a further 17% were saved subsequent surgery by utilising IOA, since they had immediate axillary clearance. When also considering patients undergoing mastectomy, this proportion is even higher.
乳腺癌术中前哨淋巴结分析（IOA）通过术中揭示转移来减少第二次手术的需求，从而可以立即进行腋窝清扫。批评者认为，受益的患者数量有限，因为除了淋巴结状态外，其他原因通常需要进一步手术。
通过 IOA 排除因腋窝淋巴结转移以外的其他原因需要进一步手术的患者，确定避免进一步手术的女性比例。
回顾了一年中接受 IOA 前哨淋巴结活检的所有患者。分析了患者的人口统计学特征、切缘阳性、前哨淋巴结转移、进一步手术的需求以及腔镜切除的受累情况。
分析了 322 例患者：253 例接受保乳手术[BCS]，69 例接受乳房切除术。IOA 显示 81 例（25.2%）患者[25 例接受乳房切除术，56 例接受 BCS]发生转移，立即进行了腋窝清扫。43 例 BCS 患者（17%）除了前哨淋巴结受累外，无需进一步手术。39 例患者需要进一步进行肿瘤手术：16 例切除边缘；13 例完成乳房切除术；6 例切除边缘后乳房切除术；3 例完成腋窝清扫术；1 例切除复发灶。20.6%的患者有任何环形组织学边缘受累。28.5%的患者在初次手术时进行了腔镜切除，其中大多数无恶性肿瘤。20 例乳房切除术患者有一致的明确组织学，避免了第二次手术。总的来说，通过 IOA，该队列中有 19.6%的患者避免了第二次手术。
大约 15%的乳腺癌保乳手术患者需要进一步手术。然而，通过 IOA，有 17%的患者可以避免进一步手术，因为他们立即进行了腋窝清扫。如果同时考虑乳房切除术患者，这个比例甚至更高。
