Johnson Julian, Esserman Laura, Ewing Cheryl, Alvarado Michael, Park Catherine, Fowble Barbara
Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA.
Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Ann Surg Oncol. 2016 Mar;23(3):715-21. doi: 10.1245/s10434-015-4971-8. Epub 2015 Dec 29.
Invasive chest wall recurrences (CWR) following mastectomy are typically treated with surgical excision, radiation therapy (RT) to the chest wall and supraclavicular (SCV) region, and appropriate systemic therapy. Repeat axillary surgery is not routinely performed if the axilla is clinically negative. We evaluated sentinel node biopsy (SNB) in patients with an isolated invasive CWR, for identification and biopsy rates, non-axillary drainage, and clinical implications for radiation fields and outcome.
Between 2008 and 2013, 12/19 women with an isolated invasive CWR had sentinel node (SN) mapping with Tc99m. Median age was 53 years, and 92% (11/12) had initial path N0 disease. All had prior SNB, with axillary dissection in one patient.
Overall, 83% (10/12) had successful mapping, with 70% (7/10) having an axillary SN. Ninety percent (9/10) had successful axillary node biopsy, with one patient having positive nodes. SCV RT was omitted in those with negative axillary nodes. With a median follow-up of 4.6 years from recurrence, there have been no SCV recurrences and no instances of lymphedema.
SNB is possible in women with an isolated CWR with acceptable identification and biopsy rates. Omission of routine irradiation of the SCV region has not jeopardized regional control and results in decreased morbidity.
乳房切除术后的侵袭性胸壁复发（CWR）通常采用手术切除、胸壁及锁骨上（SCV）区域放射治疗（RT）以及适当的全身治疗。如果腋窝临床检查为阴性，则不常规进行再次腋窝手术。我们评估了孤立性侵袭性CWR患者的前哨淋巴结活检（SNB），以确定其识别率和活检率、非腋窝引流情况以及对放射野和预后的临床意义。
2008年至2013年间，12/19例孤立性侵袭性CWR女性患者接受了99m锝前哨淋巴结（SN）定位。中位年龄为53岁，92%（11/12）患者最初病理分期为N0期。所有患者均曾接受过SNB，其中1例患者接受过腋窝清扫术。
总体而言，83%（10/12）患者成功定位，70%（7/10）患者有腋窝前哨淋巴结。90%（9/10）患者腋窝淋巴结活检成功，1例患者淋巴结阳性。腋窝淋巴结阴性患者未接受SCV区域放疗。自复发以来，中位随访4.6年，未出现SCV区域复发及淋巴水肿病例。
对于孤立性CWR女性患者，SNB是可行的，其识别率和活检率均可接受。省略SCV区域的常规放疗并未影响区域控制，且降低了发病率。
