Tan Chuan, Caragata Rebecca, Bennett Ian
Breast and Endocrine Surgery Unit, Princess Alexandra Hospital, Wolloongabba, Queensland, Australia.
Breast J. 2017 Jul;23(4):410-414. doi: 10.1111/tbj.12754. Epub 2017 Jan 24.
The aim of this study was to review the outcomes of a series of breast cancer patients who underwent sentinel node biopsy inclusive of lymphoscintigraphy, and to assess the incidence of internal mammary node (IMN) metastatic positivity at exploration and whether these findings influenced treatment. Between April 2001 and December 2012, 581 breast cancer patients at Princess Alexandra Hospital underwent preoperative lymphoscintigraphy in the course of the performance of sentinel node biopsy. Analysis was performed of those patients who demonstrated radio-isotope uptake to the IMN chain, and who had sentinel node biopsy of the IMN's and were found to have metastatic involvement. Assessment was made to determine whether the finding of IMN metastases changed the adjuvant systemic management of these patients, and to review complication rates. 95 of 581 (16.4%) patients with preoperative breast lymphoscintigraphy had lymphatic mapping to the IMN chain. 51 (54%) of these patients had IMN chain surgically explored and IMN nodes were found in 35 of these patients (success rate of 69%). Of these, three patients (3/35 = 8.6%) had metastatic involvement of the IMN sentinel node group. All three IMN positive patients received adjuvant breast radiotherapy, chemotherapy, and hormonal therapy. In four patients (7.8%) IMN surgical exploration was complicated by pneumothorax. Only a small proportion of breast cancer patients were found to have metastasic involvement of the IMN chain and which did not significantly change their adjuvant therapy management. These findings suggest that the benefits of exploration of the IMN chain in breast cancer patients are limited and may be outweighed by the risk of complications.
本研究的目的是回顾一系列接受前哨淋巴结活检（包括淋巴闪烁显像）的乳腺癌患者的治疗结果，评估术中内乳淋巴结（IMN）转移阳性的发生率，以及这些结果是否会影响治疗。2001年4月至2012年12月期间，亚历山德拉公主医院的581例乳腺癌患者在进行前哨淋巴结活检时接受了术前淋巴闪烁显像。对那些显示放射性同位素摄取至IMN链、对IMN进行了前哨淋巴结活检且发现有转移累及的患者进行了分析。评估确定IMN转移的发现是否改变了这些患者的辅助全身治疗，并回顾了并发症发生率。581例术前进行乳腺淋巴闪烁显像的患者中，95例（16.4%）有淋巴管造影至IMN链。其中51例（54%）患者接受了IMN链的手术探查，35例患者发现有IMN淋巴结（成功率为69%）。其中，3例患者（3/35 = 8.6%）的IMN前哨淋巴结组有转移累及。所有3例IMN阳性患者均接受了辅助性乳腺放疗、化疗和激素治疗。4例患者（7.8%）的IMN手术探查并发气胸。仅一小部分乳腺癌患者被发现有IMN链转移累及，且这并未显著改变其辅助治疗管理。这些发现表明，对乳腺癌患者进行IMN链探查的益处有限，且可能被并发症风险所抵消。
