Cork University Hospital, Breast Research Centre, Cork, Ireland.
University College Cork, Department of Medicine and Health, Cork, Ireland.
Breast. 2018 Apr;38:171-174. doi: 10.1016/j.breast.2018.01.003. Epub 2018 Feb 3.
The presence of extranodal extension (ENE) is well documented as a predictor of non-sentinel lymph node (NSLN) metastasis. The ACOSOG Z0011 trial (2011) concluded that patients who satisfy criteria including the absence of sentinel lymph node (SLN) ENE can forgo axillary clearance (AC). Currently there are no studies analysing the rate of ENE in NSLN metastasis in which the sentinel node was positive but had no ENE. Determining this incidence will help determine if current paradigms are resulting in residual ENE in NSLN metastasis by forgoing AC based on the Z0011 trial..
This study determined incidence of ENE at NSLN metastasis in patients with a positive SLN biopsy without ENE in 162 symptomatic breast cancer patients who underwent AC between 2009 and 2014 at Cork University Hospital Breast Cancer Service, a teaching hospital of University College Cork.
Of 965 sentinel node biopsies performed 251 were identified as SLN positive, 162 (64.5%) underwent further AC. Of the 162 patients, 56.8% (92/162) were positive for ENE at SLN, of these 57.6% (53/92) had NSLN metastasis versus 17.1% (12/70) in the ENE-negative group (χ test; P < 0.001). On adjusted analysis, ENE at the SLN was a significant predictor of NSLN metastasis (odds ratio [OR] 8.63; 95% confidence interval [CI] 3.26-22.86; P < 0.001). The incidence of NSLN-ENE in patients without SLN-ENE was 1/70 (1.4%) compared with 33.7% (31/92) in patients who had ENE at the SLN (χ test; P < 0.001).
ENE at the SLN is an independent predictor of NSLN involvement; its absence significantly reduces the likelihood of ENE in NSLN metastasis..
结外侵犯（ENE）的存在是预测非前哨淋巴结（NSLN）转移的一个很好的指标。ACOSOG Z0011 试验（2011 年）得出的结论是，满足包括前哨淋巴结（SLN）无 ENE 在内的标准的患者可以避免腋窝清扫（AC）。目前尚无研究分析在 SLN 阳性但无 ENE 的情况下，NSLN 转移中 ENE 的发生率。确定这一发生率将有助于确定是否根据 Z0011 试验，基于放弃 AC 的情况下，当前的模式是否导致 NSLN 转移中仍存在残留的 ENE。
本研究在 2009 年至 2014 年期间在科克大学医院乳腺癌服务中心（科克大学的教学医院）接受 AC 的 162 例有症状乳腺癌患者中，确定了 SLN 活检阳性且无 ENE 的患者中 NSLN 转移中 ENE 的发生率。
在 965 例前哨淋巴结活检中，有 251 例被确定为 SLN 阳性，其中 162 例（64.5%）接受了进一步的 AC。在 162 例患者中，56.8%（92/162）的 SLN 存在 ENE，其中 57.6%（53/92）有 NSLN 转移，而在 ENE 阴性组中为 17.1%（12/70）（卡方检验；P<0.001）。在调整分析中，SLN 处的 ENE 是 NSLN 转移的显著预测因子（比值比 [OR] 8.63；95%置信区间 [CI] 3.26-22.86；P<0.001）。在无 SLN-ENE 的患者中，NSLN-ENE 的发生率为 1/70（1.4%），而在 SLN 处有 ENE 的患者中为 33.7%（31/92）（卡方检验；P<0.001）。
SLN 处的 ENE 是 NSLN 受累的独立预测因子；其缺失显著降低了 NSLN 转移中存在 ENE 的可能性。
