Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.
Department of Surgical Oncology, Institute of Oncology and Radiology of Serbia, Pasterova 14, Belgrade, Serbia.
BMC Cancer. 2018 Feb 5;18(1):137. doi: 10.1186/s12885-018-4062-x.
Despite the recent changes in the treatment of the axilla in selected breast cancer patient, positive sentinel lymph node (SLN) in patients undergoing mastectomy still necessitates axillary lymph node dissection (ALND). In invasive lobular carcinoma (ILC), pre-operative detection of the lymph node metastasis may be demanding due to its unique morphology. The aim of this study was to examine the benefit of preoperative axillary ultrasound (AUS), ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and intra-operative imprint cytology (IIC), in order to avoid two-stage axillary surgery in patients with ILC undergoing mastectomy.
The object of this study were 102 patients (median age 52, range 34-73 years) with clinically non-suspicious axilla in whom 108 mastectomies were performed after a pre-operative AUS investigation. Whenever a metastasis was detected in a sentinel lymph node, ALND was done. Reports of the pre-operative AUS investigation, US-FNAB, and IIC were compared with definitive histopathological reports of surgical specimens.
In 46 cases lymph node metastases were diagnosed. AUS suspicious lymph nodes were found in 29/108 cases and histopathology confirmed metastases in 22/30 cases. US-FNAB was performed in 29 cases with AUS suspicious lymph nodes. Cytology proved metastases in 11/29 cases. Histopathology confirmed metastases in 10/11 cases with only isolated tumor cells found in one case. IIC investigation was performed in 63 cases and in 10/27 cases metastases were confirmed by histopathology. Pre-operative AUS, US-FNAB, and/or IIC investigation enabled ALND during a single surgical procedure in 20/46 patients with metastases in lymph nodes.
Pre-operative AUS, US-FNAB, and/or IIC are/is beneficial in patients with ILC planned for mastectomy in order to decrease the number of two stage axillary procedures.
尽管在某些选定的乳腺癌患者的治疗中腋窝的处理方式发生了变化，但在接受乳房切除术的患者中，阳性前哨淋巴结 (SLN) 仍然需要进行腋窝淋巴结清扫术 (ALND)。在浸润性小叶癌 (ILC) 中，由于其独特的形态，术前检测淋巴结转移可能具有挑战性。本研究的目的是检查术前腋窝超声 (AUS)、超声引导下细针抽吸活检 (US-FNAB) 和术中印片细胞学 (IIC) 的益处，以便避免在接受乳房切除术的 ILC 患者中进行两阶段腋窝手术。
本研究对象为 102 例（中位年龄 52 岁，范围 34-73 岁）临床腋窝无可疑的患者，这些患者在术前 AUS 检查后进行了 108 例乳房切除术。只要在 SLN 中检测到转移，就进行 ALND。将术前 AUS 检查、US-FNAB 和 IIC 的报告与手术标本的明确组织病理学报告进行比较。
在 46 例病例中诊断出淋巴结转移。在 108 例病例中，AUS 可疑淋巴结在 29 例中发现，组织病理学证实转移在 22/30 例中。在 29 例 AUS 可疑淋巴结中进行了 US-FNAB。细胞学在 11/29 例中证实转移。组织病理学在 10/11 例中证实转移，仅在 1 例中发现孤立肿瘤细胞。在 63 例病例中进行了 IIC 检查，在 10/27 例中组织病理学证实转移。在 20/46 例有淋巴结转移的患者中，术前 AUS、US-FNAB 和/或 IIC 检查可在单次手术中进行 ALND。
术前 AUS、US-FNAB 和/或 IIC 有利于计划接受乳房切除术的 ILC 患者，以减少两阶段腋窝手术的数量。
