Mohamed O O, Neary P M, Fiuza-Castineira C, O'Donoghue G T
South Eastern Cancer Centre, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
Ir J Med Sci. 2015 Mar;184(1):189-94. doi: 10.1007/s11845-014-1085-4. Epub 2014 Mar 2.
Axillary node status is a predictor of breast cancer survival. Axillary node dissection (ALND) following positive sentinel node biopsy (SLNB) is challenged by the American College of Surgeons Z0011 trial, where clinically/radiologically node-negative, SLNB positive early stage patients failed to derive therapeutic benefit from ALND at 6 years.
To quantify the rates of non-sentinel lymph node positivity after ALND in all breast cancer stages. To assess Z0011 trial result application to an Irish patient population.
Retrospective review of a prospectively maintained database of clinically node-negative patients undergoing breast conserving surgery and ALND for a positive SLNB from January 2011 to January 2012.
Of 174 new breast cancers diagnosed, 144 underwent surgery of which 127 patients were clinically/radiologically node-negative; 46 patients were SLNB positive; 34 (73.9 %) proceeded to ALND. Of 9 T1 tumours, 3 (33.3 %) had further positive nodes on ALND. Of 24 T2 tumours, 11 (45.8 %) had further positive nodes on ALND. All 3 (100 %) T3/T4 tumours had further positive nodes on ALND. Mean numbers of sentinel and axillary nodes harvested were 2.3 and 15.2, respectively. In the SLNB positive, ALND negative group, 12 of 18 (66.7 %) patients were <60 years versus 14 of 17 (82.4 %) in the SLNB positive, ALND positive group. This may be indicative that younger women have a trend toward node positivity following ALND for a positive SLNB.
These data suggest that a significant proportion (41.9 %) of T1/T2 tumours undergoing ALND following positive SLNB have further positive nodes. It may be premature to exclude ALND in patients with T1/T2 tumours following a positive SLNB.
腋窝淋巴结状态是乳腺癌生存的一个预测指标。美国外科医师学会Z0011试验对前哨淋巴结活检（SLNB）阳性后行腋窝淋巴结清扫术（ALND）提出了挑战，该试验中临床/放射学检查淋巴结阴性、SLNB阳性的早期患者在6年时未从ALND中获得治疗益处。
量化所有乳腺癌分期患者行ALND后非前哨淋巴结阳性率。评估Z0011试验结果在爱尔兰患者群体中的应用情况。
回顾性分析2011年1月至2012年1月期间前瞻性维护的数据库，该数据库纳入了因SLNB阳性而接受保乳手术和ALND的临床淋巴结阴性患者。
在174例新诊断的乳腺癌患者中，144例接受了手术，其中127例患者临床/放射学检查淋巴结阴性；46例患者SLNB阳性；34例（73.9%）接受了ALND。在9例T1期肿瘤患者中，3例（33.3%）行ALND后有更多阳性淋巴结。在24例T2期肿瘤患者中，11例（45.8%）行ALND后有更多阳性淋巴结。所有3例（100%）T3/T4期肿瘤患者行ALND后均有更多阳性淋巴结。前哨淋巴结和腋窝淋巴结的平均获取数量分别为2.3个和15.2个。在SLNB阳性、ALND阴性组中，18例患者中有12例（66.7%）年龄<60岁，而在SLNB阳性、ALND阳性组中，17例患者中有14例（82.4%）年龄<60岁。这可能表明，对于SLNB阳性的年轻女性，行ALND后有淋巴结阳性的趋势。
这些数据表明，SLNB阳性后行ALND的T1/T2期肿瘤患者中有相当比例（41.9%）有更多阳性淋巴结。对于SLNB阳性的T1/T2期肿瘤患者排除ALND可能为时过早。
