Pilewskie Melissa, Jochelson Maxine, Gooch Jessica C, Patil Sujata, Stempel Michelle, Morrow Monica
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
J Am Coll Surg. 2016 Feb;222(2):138-45. doi: 10.1016/j.jamcollsurg.2015.11.013. Epub 2015 Nov 25.
American College of Surgeons Oncology Group (ACOSOG) Z0011 results support the omission of axillary lymph node dissection (ALND) in women with less than 3 positive sentinel lymph nodes (SLNs) undergoing breast-conserving surgery (BCS) and radiation therapy. We sought to determine if abnormal axillary imaging is predictive of the need for ALND in this population.
Patients with cT1-2N0 breast cancer by physical examination undergoing BCS were managed according to Z0011 criteria independent of axillary imaging. Patient characteristics and rates of ALND were compared among those with and without abnormal lymph nodes (LNs) detected by mammogram, ultrasound (US), or MRI. All available axillary imaging was reviewed by 1 breast radiologist.
Between August 2010 and December 2013, 3,253 breast cancer patients were treated with BCS and SLN biopsy; 425 patients met Z0011 criteria (cT1-2N0) and had nodal metastasis on SLN biopsy. Clinicopathologic features were median patient age, 58 years; median tumor size, 1.8 cm; 85% ductal histology; and 89% estrogen receptor positive. All women had a mammogram, 242 had axillary US, 172 had MRI. Abnormal LNs were seen on 7%, 25%, and 30% of mammograms, US, and MRIs, respectively. Although abnormal LNs on mammogram or US were associated with a significant increase in ALND and a non-significant trend was seen with MRI, 68% to 73% of women with abnormal axillary imaging did not require ALND.
Among clinically node-negative patients with abnormal axillary imaging, 71% did not meet criteria for ALND and were spared further surgical morbidity. Abnormal nodes on US, MRI, or mammogram in clinically node-negative patients are not reliable indicators of the need for ALND.
美国外科医师学会肿瘤学组（ACOSOG）Z0011研究结果支持，对于接受保乳手术（BCS）和放射治疗且前哨淋巴结（SLN）阳性数少于3个的女性，可不进行腋窝淋巴结清扫（ALND）。我们试图确定腋窝影像学异常是否可预测该人群对ALND的需求。
通过体格检查诊断为cT1-2N0乳腺癌且接受BCS的患者，按照Z0011标准进行治疗，与腋窝影像学检查无关。比较通过乳房X线摄影、超声（US）或磁共振成像（MRI）检测出有或无异常淋巴结（LN）的患者的特征及ALND发生率。1名乳腺放射科医生对所有可用的腋窝影像学检查进行了评估。
2010年8月至2013年12月期间，3253例乳腺癌患者接受了BCS和SLN活检；425例患者符合Z0011标准（cT1-2N0）且SLN活检发现有淋巴结转移。临床病理特征为患者年龄中位数58岁；肿瘤大小中位数1.8 cm；85%为导管组织学类型；89%雌激素受体阳性。所有女性均接受了乳房X线摄影，242例接受了腋窝US检查，172例接受了MRI检查。乳房X线摄影、US和MRI检查分别发现7%、25%和30%的LN异常。虽然乳房X线摄影或US检查发现的LN异常与ALND显著增加相关，MRI检查有不显著的趋势，但68%至73%腋窝影像学异常的女性不需要进行ALND。
在临床腋窝淋巴结阴性且腋窝影像学异常的患者中，71%不符合ALND标准，避免了进一步的手术并发症。临床腋窝淋巴结阴性患者的US、MRI或乳房X线摄影检查发现的异常淋巴结并非ALND需求的可靠指标。
