Eldweny Hany, Alkhaldy Khaled, Alsaleh Noha, Abdulsamad Majda, Abbas Ahmed, Hamad Ahmad, Mounib Sherif, Essam Tarek, Kukawski Pawel, Bobin Jean-Yves, Oteifa Medhat, Amanguono Henney, Abulhoda Fawaz, Usmani Sharjeel, Elbasmy Amany
Department of Surgical Oncology, Kuwait Cancer Control Center, Kuwait.
J Egypt Natl Canc Inst. 2012 Mar;24(1):23-30. doi: 10.1016/j.jnci.2011.12.004. Epub 2012 Jan 23.
Sentinel Lymph Node Biopsy (SLNB) procedure was found to be an accurate method of staging the axilla in patients with early stage breast cancer. The standard of care for breast cancer patients with positive SLN metastasis includes complete Axillary Lymph Node Dissection (ALND). However, in 40-70% of patients, the SLN is the only involved axillary node. Factors predicting non SLN metastasis should be identified in order to define subgroups of patients with positive SLN in whom the axilla may be staged by SLNB alone.
To identify the factors predicting metastatic involvement of the non-SLNs in breast cancer patients having SLN metastasis.
Data were collected and analyzed from 80 patients with early stage invasive breast cancer (T1, T2, N0, M0) who underwent SLNB at the Surgical Oncology Department, Kuwait Cancer Control Center (KCCC) between November 2004 and February 2009. SLNB was performed using a combined technique (radioactive colloid, and blue dye) in the majority of cases. In some cases, only one technique was used. Complete ALND was performed in the case of failure of SLN identification and in patients with positive SLN. Multiple variables (patient, tumor, and SLN characteristics) were tested as possible predictors of nonsentinel lymph node metastasis.
The mean age of patients at diagnosis was 46.6years. The median tumor size was 2cm. The SLN identification rate was 96.2% (77 out of 80 patients). The SLN was positive in 24 patients (31%), and half of these showed evidence of capsular invasion. The median number of SLNs removed was two. The median number of positive SLNs was one. The incidence of non-SLN metastasis associated with positive SLN was 50% (12 out of 24 patients). Lymphovascular invasion was found to be the only factor associated with non-SLN metastases. In addition, two trends were observed, though they did not reach the statistical significance: the first is that the majority of patients having capsular invasion of the SLN (8 out of 12 patients, 67%) had positive non-SLN metastasis, and the second is that the patients having more than one SLN metastasis were more likely to have non-SLN metastasis (4 out of 5, 80%).
In the current pilot study, only the lymphovascular invasion in the area of the primary tumor was found to be significantly related to the nonsentinel lymph node metastasis. There was a tendency toward higher incidence of nonsentinel lymph node metastasis associated with the number of positive SLN and capsular invasion of SLN, though this did not reach the statistical significance. This could be attributed to the small number of patients recruited. Further evaluation of the predictors of nonsentinel lymph node metastasis on a larger number of patients is required. The validation of these predictors in prospective studies may enable approximately half of early stage breast cancer patients with positive SLN to be staged with SLNB alone while avoiding the morbidity of unnecessary ALND.
前哨淋巴结活检（SLNB）被认为是早期乳腺癌患者腋窝分期的一种准确方法。前哨淋巴结转移阳性的乳腺癌患者的标准治疗方案包括完整的腋窝淋巴结清扫术（ALND）。然而，在40%-70%的患者中，前哨淋巴结是腋窝唯一受累的淋巴结。应确定预测非前哨淋巴结转移的因素，以便明确前哨淋巴结转移阳性且腋窝可仅通过SLNB进行分期的患者亚组。
确定前哨淋巴结转移的乳腺癌患者中非前哨淋巴结发生转移的预测因素。
收集并分析了2004年11月至2009年2月期间在科威特癌症控制中心（KCCC）外科肿瘤学部门接受SLNB的80例早期浸润性乳腺癌（T1、T2、N0、M0）患者的数据。大多数病例采用联合技术（放射性胶体和蓝色染料）进行SLNB。在某些情况下，仅使用了一种技术。在前哨淋巴结识别失败的病例以及前哨淋巴结阳性的患者中进行了完整的ALND。对多个变量（患者、肿瘤和前哨淋巴结特征）作为非前哨淋巴结转移的可能预测因素进行了检测。
患者诊断时的平均年龄为46.6岁。肿瘤大小的中位数为2cm。前哨淋巴结识别率为96.2%（80例患者中的77例）。24例患者（31%）的前哨淋巴结为阳性，其中一半有包膜侵犯的证据。切除的前哨淋巴结数量中位数为2个。阳性前哨淋巴结数量中位数为1个。与前哨淋巴结阳性相关的非前哨淋巴结转移发生率为50%（24例患者中的12例）。发现淋巴管侵犯是与非前哨淋巴结转移相关的唯一因素。此外，观察到两种趋势，尽管未达到统计学意义：第一种是大多数前哨淋巴结有包膜侵犯的患者（12例患者中的8例，67%）有非前哨淋巴结转移阳性，第二种是有一个以上前哨淋巴结转移的患者更有可能有非前哨淋巴结转移（5例中的4例，80%）。
在当前的初步研究中，仅发现原发肿瘤区域的淋巴管侵犯与非前哨淋巴结转移显著相关。与阳性前哨淋巴结数量和前哨淋巴结包膜侵犯相关的非前哨淋巴结转移发生率有升高趋势，尽管未达到统计学意义。这可能归因于招募的患者数量较少。需要对更多患者进行非前哨淋巴结转移预测因素的进一步评估。在前瞻性研究中对这些预测因素进行验证可能使大约一半前哨淋巴结阳性的早期乳腺癌患者仅通过SLNB进行分期，同时避免不必要的ALND带来的并发症。
