Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 138-736, South Korea.
Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Breast Cancer Res Treat. 2017 Nov;166(2):511-518. doi: 10.1007/s10549-017-4422-2. Epub 2017 Aug 7.
To analyze the prognostic role of pathologic confirmation of internal mammary lymph nodes (IMNs) for breast cancer patients who received neoadjuvant chemotherapy.
Of the patients who were treated with neoadjuvant chemotherapy, surgery, and radiation therapy between 2009 and 2013, 114 women had suspicious IMNs and FNAB was attempted. Clinical IMN metastasis was diagnosed by 18F-FDG PET/CT positivity or pathologic confirmation (N = 70). Patients were divided into the FNAB(+) or FNAB(-) IMN group.
The pathologic confirmation rate was 57% (40 of 70 patients). Rates were 74% in US-positive, 70% in MRI-positive, and 55% in PET-positive patients. Nodal stage was cN2b (6%) or cN3b (94%). Five-year progression-free survival (PFS) was significantly worse in patients with FNAB(+) IMN metastasis than FNAB(-) IMN metastasis (61% vs. 87%, P = 0.03). FNAB(+) IMN patients showed worse distant metastasis and regional recurrence-free survival without statistical significance (69% vs. 86%, P = 0.06, and 81% vs. 96%, P = 0.06). With median follow-up of 50.5 months (13.0-97.0 months), overall survival at 5 years was 77%, and PFS was 72%.
Patients with FNAB-proven IMN metastasis had worse treatment outcomes compared to patients with clinically diagnosed IMN metastasis in cN2b/N3b breast cancer.
分析接受新辅助化疗的乳腺癌患者内乳淋巴结（IMN）病理证实的预后作用。
在 2009 年至 2013 年间接受新辅助化疗、手术和放疗的患者中，有 114 名女性 IMN 可疑，尝试了细针穿刺活检（FNAB）。通过 18F-FDG PET/CT 阳性或病理证实（N=70）诊断临床 IMN 转移。患者分为 FNAB（+）或 FNAB（-）IMN 组。
病理证实率为 57%（70 例患者中的 40 例）。US 阳性患者为 74%，MRI 阳性患者为 70%，PET 阳性患者为 55%。淋巴结分期为 cN2b（6%）或 cN3b（94%）。FNAB（+）IMN 转移患者的 5 年无进展生存（PFS）显著低于 FNAB（-）IMN 转移患者（61% vs. 87%，P=0.03）。FNAB（+）IMN 患者的远处转移和区域无复发生存率较差，但无统计学意义（69% vs. 86%，P=0.06 和 81% vs. 96%，P=0.06）。中位随访 50.5 个月（13.0-97.0 个月）时，5 年总生存率为 77%，PFS 为 72%。
与临床诊断为 cN2b/N3b 乳腺癌的 IMN 转移患者相比，FNAB 证实的 IMN 转移患者的治疗结果较差。
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