Royal Berkshire Hospital, Reading, United Kingdom.
Royal Berkshire Hospital, Reading, United Kingdom.
Clin Breast Cancer. 2014 Feb;14(1):68-73. doi: 10.1016/j.clbc.2013.09.005. Epub 2013 Sep 30.
Sentinel lymph node biopsy (SLNB) is the standard procedure performed to stage the axillae, and axillary node clearance (ANC) or radiotherapy is the treatment for nodal involvement. The aims of this study were to assess (1) the role of preoperative axillary ultrasonography (US), (2) the number of positive lymph nodes on ANC after either positive SLNB results or preoperative ultrasonographically guided nodal biopsy, and (3) the role of ANC in patients with node-positive breast cancer.
All patients with invasive breast cancer and axillary node involvement (but clinically negative nodes on presentation) who underwent ANC between January 2008 and December 2009 were identified, and information regarding clinicopathologic parameters and the nodal yield was collected. ANC was performed for 3 groups: patients with micrometastasis seen in SLNB specimens, macrometastasis seen in SLNB specimens, and positive axillary nodes detected on US biopsy.
ANC was performed 141 times over the 2-year period. Forty-two percent of axillary node involvement was diagnosed by biopsy or preoperative US, and 40% of these patients received neoadjuvant chemotherapy. The remainder of cases were diagnosed by SLNB: 30% had micrometastases and 70% had macrometastases. Fifty percent of cancers with an ultrasonographic diagnosis of lymph node involvement were high grade and 56% had 4 or more positive nodes on ANC; this was significantly higher than in patients with positive SLNB results (P = .0001). Only 20% of patients with macrometastases on SLNB had 4 or more positive nodes in comparison with 56% with positive axillary lymph nodes by US (P < .0001).
The routine use of preoperative axillary US and biopsy of abnormal nodes helps in identifying high-risk patients and thus aids in planning treatment.
前哨淋巴结活检术（SLNB）是用于分期腋窝的标准程序，而腋窝淋巴结清扫术（ANC）或放疗是针对淋巴结受累的治疗方法。本研究旨在评估：（1）术前腋窝超声（US）的作用；（2）SLNB 阳性结果或术前超声引导下淋巴结活检后 ANC 中阳性淋巴结的数量；（3）ANC 在淋巴结阳性乳腺癌患者中的作用。
所有于 2008 年 1 月至 2009 年 12 月期间接受 ANC 的浸润性乳腺癌且腋窝淋巴结受累（但就诊时临床淋巴结阴性）的患者均被确定，并收集了与临床病理参数和淋巴结产量相关的信息。ANC 用于以下 3 组患者：SLNB 标本中发现微转移、SLNB 标本中发现宏转移、超声活检发现阳性腋窝淋巴结。
在 2 年期间共进行了 141 次 ANC。42%的腋窝淋巴结受累通过活检或术前 US 诊断，其中 40%的患者接受了新辅助化疗。其余病例通过 SLNB 诊断：30%有微转移，70%有宏转移。超声诊断为淋巴结受累的癌症中，50%为高级别，56%的患者 ANC 中有 4 个或更多阳性淋巴结；这明显高于 SLNB 阳性结果的患者（P =.0001）。与 SLNB 宏转移患者相比，仅 20%的患者 ANC 中有 4 个或更多阳性淋巴结，而 56%的患者经超声检查腋窝淋巴结阳性（P <.0001）。
术前腋窝 US 和异常淋巴结活检的常规应用有助于识别高危患者，从而有助于治疗计划。
