Vugts G, Maaskant-Braat A J G, Voogd A C, van Riet Y E A, Roumen R M H, Luiten E J T, Rutgers E J Th, Wyndaele D, Rutten H J T, Nieuwenhuijzen G A P
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S529-35. doi: 10.1245/s10434-015-4787-6. Epub 2015 Aug 11.
Repeat sentinel node biopsy (SNB) is an alternative to axillary lymph node dissection (ALND) for axillary staging in recurrent breast cancer. This study was conducted to determine factors associated with technical success of repeat SNB.
A total of 536 patients with locally recurrent nonmetastatic breast cancer underwent lymphatic mapping (LM) and repeat SNB in 29 Dutch hospitals.
A total of 179 patients previously underwent breast-conserving surgery (BCS) with SNB, 262 patients BCS with ALND and 61 patients mastectomy, 35 with SNB and 26 with ALND. Another 34 patients underwent breast surgery without axillary interventions. A repeat sentinel node (SN) was identified in 333 patients (62.1 %) and was successfully removed in 235 (53.5 %). The overall repeat SN identification rate was 62.1 %, varying from 35 to 100 % in the participating hospitals. Previous radiotherapy of the breast [odds ratio (OR) 0.16; 95 % confidence interval (CI) 0.03-0.84], subareolar tracer injection (OR 0.34; 95 % CI 0.16-0.73), and a 2-day LM protocol (OR 0.57; 95 % CI 0.33-0.97) after previous BCS were independently associated with failure of SN identification. Injection of a larger amount of tracer (>180 MBq) led to a higher identification rate (OR 4.40; 95 % CI 1.45-13.32).
Repeat SNB is a technically feasible procedure for axillary staging in recurrent breast cancer patients. Previous radiotherapy appears to be associated with failure of SN identification. Injection with a larger amount of tracer (>180 MBq) leads to a higher identification rate; subareolar injection and a 2-day LM protocol after previous BCS appear to be less adequate.
对于复发性乳腺癌的腋窝分期，重复前哨淋巴结活检（SNB）是腋窝淋巴结清扫术（ALND）的一种替代方法。本研究旨在确定与重复SNB技术成功相关的因素。
29家荷兰医院的536例局部复发性非转移性乳腺癌患者接受了淋巴绘图（LM）和重复SNB。
共有179例患者先前接受了保乳手术（BCS）并进行了SNB，262例患者接受了BCS并进行了ALND，61例患者接受了乳房切除术，其中35例进行了SNB，26例进行了ALND。另外34例患者接受了无腋窝干预的乳房手术。333例患者（62.1%）发现了重复前哨淋巴结（SN），其中235例（53.5%）成功切除。总体重复SN识别率为62.1%，各参与医院的识别率在35%至100%之间。先前乳房放疗[比值比（OR）0.16；95%置信区间（CI）0.03 - 0.84]、乳晕下示踪剂注射（OR 0.34；95% CI 0.16 - 0.73）以及先前BCS后采用2天LM方案（OR 0.57；95% CI 0.33 - 0.97）与SN识别失败独立相关。注射较大量示踪剂（>180 MBq）导致更高的识别率（OR 4.40；95% CI 1.45 - 13.32）。
重复SNB对于复发性乳腺癌患者的腋窝分期是一种技术上可行的方法。先前放疗似乎与SN识别失败有关。注射较大量示踪剂（>180 MBq）可导致更高的识别率；乳晕下注射以及先前BCS后采用2天LM方案似乎不太合适。
