使用夹闭淋巴结的选择性评估对淋巴结阳性乳腺癌患者新辅助治疗后腋窝评估进行改进：靶向腋窝清扫的实施
Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection.
作者信息
Caudle Abigail S, Yang Wei T, Krishnamurthy Savitri, Mittendorf Elizabeth A, Black Dalliah M, Gilcrease Michael Z, Bedrosian Isabelle, Hobbs Brian P, DeSnyder Sarah M, Hwang Rosa F, Adrada Beatriz E, Shaitelman Simona F, Chavez-MacGregor Mariana, Smith Benjamin D, Candelaria Rosalind P, Babiera Gildy V, Dogan Basak E, Santiago Lumarie, Hunt Kelly K, Kuerer Henry M
机构信息
All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
J Clin Oncol. 2016 Apr 1;34(10):1072-8. doi: 10.1200/JCO.2015.64.0094. Epub 2016 Jan 25.
PURPOSE
Placing clips in nodes with biopsy-confirmed metastasis before initiating neoadjuvant therapy allows for evaluation of response in breast cancer. Our goal was to determine if pathologic changes in clipped nodes reflect the status of the nodal basin and if targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of clipped nodes, improves the false-negative rate (FNR) compared with SLND alone.
METHODS
A prospective study of patients with biopsy-confirmed nodal metastases with a clip placed in the sampled node was performed. After neoadjuvant therapy, patients underwent axillary surgery and the pathology of the clipped node was compared with other nodes. Patients undergoing TAD had SLND and selective removal of the clipped node using iodine-125 seed localization. The FNR was determined in patients undergoing complete axillary lymphadenectomy (ALND).
RESULTS
Of 208 patients enrolled in this study, 191 underwent ALND, with residual disease identified in 120 (63%). The clipped node revealed metastases in 115 patients, resulting in an FNR of 4.2% (95% CI, 1.4 to 9.5) for the clipped node. In patients undergoing SLND and ALND (n = 118), the FNR was 10.1% (95% CI, 4.2 to 19.8), which included seven false-negative events in 69 patients with residual disease. Adding evaluation of the clipped node reduced the FNR to 1.4% (95% CI, 0.03 to 7.3; P = .03). The clipped node was not retrieved as an SLN in 23% (31 of 134) of patients, including six with negative SLNs but metastasis in the clipped node. TAD followed by ALND was performed in 85 patients, with an FNR of 2.0% (1 of 50; 95% CI, 0.05 to 10.7).
CONCLUSION
Marking nodes with biopsy-confirmed metastatic disease allows for selective removal and improves pathologic evaluation for residual nodal disease after chemotherapy.
目的
在开始新辅助治疗前对经活检证实有转移的淋巴结放置夹子，有助于评估乳腺癌的治疗反应。我们的目标是确定夹闭淋巴结的病理变化是否反映淋巴结区域的状态，以及与单纯前哨淋巴结活检（SLND）相比，包括前哨淋巴结活检和夹闭淋巴结的选择性定位及切除的靶向腋窝清扫术（TAD）是否能降低假阴性率（FNR）。
方法
对经活检证实有淋巴结转移且在取样淋巴结中放置夹子的患者进行前瞻性研究。新辅助治疗后，患者接受腋窝手术，并将夹闭淋巴结的病理与其他淋巴结进行比较。接受TAD的患者进行SLND，并使用碘-125种子定位选择性切除夹闭淋巴结。在接受完整腋窝淋巴结清扫术（ALND）的患者中确定FNR。
结果
本研究纳入的208例患者中，191例接受了ALND，其中120例（63%）发现有残留疾病。夹闭淋巴结在115例患者中显示有转移，夹闭淋巴结的FNR为4.2%（95%CI，1.4至9.5）。在接受SLND和ALND的患者（n = 118）中，FNR为10.1%（95%CI，4.2至19.8），其中69例有残留疾病的患者中有7例假阴性事件。增加对夹闭淋巴结的评估可将FNR降至1.4%（95%CI，0.03至7.3；P = 0.03）。23%（134例中的31例）的患者未将夹闭淋巴结作为SLN取出，其中6例SLN为阴性但夹闭淋巴结有转移。85例患者先进行TAD后进行ALND，FNR为2.0%（50例中的1例；95%CI，0.05至10.7）。
结论
对经活检证实有转移性疾病的淋巴结进行标记，有助于选择性切除，并改善化疗后残留淋巴结疾病的病理评估。
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