Moorman A M, Bourez R L J H, Heijmans H J, Kouwenhoven E A
Departments of Surgery, Hospital Group Twente, Almelo, The Netherlands,
Ann Surg Oncol. 2014 Sep;21(9):2904-10. doi: 10.1245/s10434-014-3674-x. Epub 2014 Apr 9.
The sentinel lymph node biopsy (SLNB) procedure is the method of choice for the identification and monitoring of regional lymph node metastases in patients with breast cancer. In the case of a positive sentinel lymph node (SLN), additional lymph node dissection is still warranted for regional control, although 40-65 % have no additional axillary disease. Recent studies show that after breast-conserving surgery, SLNB, and adjuvant systemic therapy, there is no significant difference between recurrence-free period and overall survival if there are ≤2 positive axillary nodes. The purpose of this study was preoperative identification of patients with limited axillary disease (≤2 macrometastases) by using ultrasonography.
Data from 1,103 consecutive primary breast cancer patients with tumors smaller than 50 mm, no palpable adenopathy, and a maximum of 2 SLNs with macrometastases were collected. The variable of interest was US of the axilla.
Of the 1,103 patients included, 1,060 remained after exclusion criteria. Of these, 102 (9.6 %) had more than 2 positive axillary nodes on ALND. Selected by unsuspected US, the chance of having >2 positive lymph nodes (LNs) is substantially lower (4.2 %). This is significant on univariate and multivariate analysis. After excluding the patients with extracapsular extension of the SLN, the chance of having >2 positive LNs is only 2.6 %. For pT1-2, this is 2.2 %.
The risk of more than 2 positive axillary nodes is relatively small in patients with cT1-2 breast cancer. US of the axilla helps in further identifying patients with a minimal risk of additional axillary disease, putting ALND up for discussion.
前哨淋巴结活检（SLNB）是识别和监测乳腺癌患者区域淋巴结转移的首选方法。在前哨淋巴结（SLN）阳性的情况下，尽管40%-65%的患者没有其他腋窝疾病，但仍需进行额外的淋巴结清扫以进行区域控制。最近的研究表明，在保乳手术、SLNB和辅助全身治疗后，如果腋窝淋巴结阳性数≤2个，无复发生存期和总生存期之间没有显著差异。本研究的目的是通过超声检查术前识别腋窝疾病局限（≤2个大转移灶）的患者。
收集1103例连续的原发性乳腺癌患者的数据，这些患者肿瘤小于50mm，无可触及的腺病，且最多有2个SLN出现大转移灶。感兴趣的变量是腋窝超声检查。
在纳入的1103例患者中，排除标准后剩余1060例。其中，102例（9.6%）在腋窝淋巴结清扫（ALND）时发现腋窝淋巴结阳性数超过2个。通过未怀疑的超声检查选择，腋窝淋巴结阳性数>2个的几率显著降低（4.2%）。这在单因素和多因素分析中具有显著性。排除SLN有包膜外侵犯的患者后，腋窝淋巴结阳性数>2个的几率仅为2.6%。对于pT1-2期患者，这一几率为2.2%。
cT1-2期乳腺癌患者腋窝淋巴结阳性数超过2个的风险相对较小。腋窝超声有助于进一步识别腋窝疾病风险极小的患者，从而引发对腋窝淋巴结清扫的讨论。
