Department of General Surgery, University Hospital Ayr, Ayr, Scotland, United Kingdom.
Department of General Surgery, University Hospital Ayr, Ayr, Scotland, United Kingdom.
Clin Breast Cancer. 2017 Nov;17(7):578-580. doi: 10.1016/j.clbc.2017.05.005. Epub 2017 May 19.
Sentinel lymph node biopsy (SLNB) is the reference standard for axillary staging in all patients with invasive breast cancer. Surgical practices are being reviewed for a more conservative approach to the axilla.
In this audit, we studied the incidence of axillary disease in patients with ultrasound negative axilla. The selection criteria are similar to an ongoing national study: female patients, age > 50 years, primary breast lesion < 1.5 cm in size, and estrogen receptor-positive and HER-2 (human epidermal growth factor receptor 2)-negative disease. We studied the data of all breast cancer patients, January 2013 to December 2015, in a population of 350,000 with annual incidence of about 400 cancers.
In our patient subset, we studied a total of 261 patients. The average false-negative (FN) rate with axillary ultrasound (AUS) per year was noted to be 10.7% (P = .0052). This is comparable to SLNB, which has a FN rate of approximately 10%. The sensitivity of AUS to exclude axillary disease was 89.3% (95% confidence interval, 84.9-92.3).
Because the FN rate of AUS and SLNB are comparable, the former can possibly replace the latter, at least in a subset of early breast cancer patients. This finding has wide implications.
前哨淋巴结活检（SLNB）是所有浸润性乳腺癌患者腋窝分期的参考标准。目前正在对手术实践进行审查，以寻求对腋窝进行更保守的处理。
在本次审计中，我们研究了腋窝超声阴性患者腋窝疾病的发生率。选择标准与正在进行的全国性研究相似：女性患者，年龄>50 岁，原发性乳腺病变<1.5cm 大小，雌激素受体阳性和 HER-2（人表皮生长因子受体 2）阴性疾病。我们研究了 2013 年 1 月至 2015 年 12 月期间 35 万例人群中所有乳腺癌患者的数据，每年的癌症发病率约为 400 例。
在我们的患者亚组中，共研究了 261 例患者。每年腋窝超声（AUS）的平均假阴性（FN）率为 10.7%（P=0.0052）。这与 SLNB 相似，SLNB 的 FN 率约为 10%。AUS 排除腋窝疾病的敏感性为 89.3%（95%置信区间，84.9-92.3）。
由于 AUS 和 SLNB 的 FN 率相当，因此前者可能至少可以替代后者，尤其是在早期乳腺癌患者的亚组中。这一发现具有广泛的意义。
