Kuru Bekir, Yuruker Savas, Sullu Yurdanur, Gursel Bilge, Ozen Necati
a Department of General Surgery , Ondokuz Mayis University School of Medicine , Samsun , Turkey.
b Department of Pathology , Ondokuz Mayis University School of Medicine , Samsun , Turkey.
J Invest Surg. 2019 Jan;32(1):48-54. doi: 10.1080/08941939.2017.1375051. Epub 2017 Sep 25.
The aims of our study were to determine the incidence of axillary recurrence and arm morbidity in T1-2 invasive breast cancer patients with macrometastases on the sentinel lymph node (SLN) who underwent breast-conserving therapy (BCT), with or without axillary lymph node dissection (ALND).
One hundred and nine T1-2 invasive breast cancer patients with macrometastases on the SLN who underwent BCT in our institution were included in the study. Patients with 1-2 positive SLN and without extra nodal extension (ENE) on the SLN did not undergo ALND (SLN-only group) and patients with ENE or patients who had >2 metastatic nodes underwent level I, II ALND (ALND group). The SLN-only group received radiotherapy to three axillary levels, the supraclavicular fossa, and ± mammaria interna. ALND group received radiotherapy to axillary level III, the supraclavicular fossa, and ± mammaria interna. The incidence of axillary recurrence and arm morbidity were investigated.
Of the 109 patients, 18 patients with >2 metastatic SLNs and 10 with ENE on the SLN underwent ALND and 81 patients underwent SLN only. Median follow-up time was 37 months (3-77). There was no axillary recurrence in SLN-only group. However, in the ALND group 1 patient had developed axillary metastasis. There were 2 objective lymphoedema and 3 arm-shoulder restriction cases in the SLN-only group, and 2 and 3 in the ALND group, respectively.
Axillary dissection could safely be omitted in patients with 1-2 macrometastatic SLN and without ENE who undergo BCT and axillary radiotherapy.
我们研究的目的是确定接受保乳治疗（BCT）的T1-2期浸润性乳腺癌患者，前哨淋巴结（SLN）有大转移灶，无论是否进行腋窝淋巴结清扫（ALND）时腋窝复发和手臂并发症的发生率。
本研究纳入了109例在我院接受BCT且SLN有大转移灶的T1-2期浸润性乳腺癌患者。SLN有1-2个转移且无结外扩展（ENE）的患者未进行ALND（仅SLN组），有ENE或转移淋巴结>2个的患者进行I、II级ALND（ALND组）。仅SLN组接受腋窝三个水平、锁骨上窝及±内乳区的放疗。ALND组接受腋窝III级水平、锁骨上窝及±内乳区的放疗。研究腋窝复发和手臂并发症的发生率。
109例患者中，18例SLN转移>2个及10例SLN有ENE的患者接受了ALND，81例患者仅接受了SLN活检。中位随访时间为37个月（3-77个月）。仅SLN组无腋窝复发。然而，ALND组有1例发生腋窝转移。仅SLN组有2例客观存在的淋巴水肿和3例手臂-肩部活动受限病例，ALND组分别有2例和3例。
对于接受BCT和腋窝放疗且SLN有1-2个大转移灶且无ENE的患者，可以安全地省略腋窝清扫。
