Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
Department of Ultrasound Imaging, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
World J Surg Oncol. 2019 Feb 20;17(1):37. doi: 10.1186/s12957-019-1582-z.
Breast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-ACOSOG Z0011 era. We aim to evaluate the ALN metastasis burden in these patients, thus to illustrate whether they can follow the ACOSOG Z0011 trial procedure.
Clinically, T1-2 N0 breast cancer patients with positive preoperative ALN biopsy (FNA group) or 1-2 positive sentinel nodes (SLNB group) were retrospectively analyzed. ALN metastasis burden was compared between the two groups, which were further analyzed in certain subtypes. An association between clinicopathological factors and ≥ 3 ALN metastasis was also analyzed.
A total of 388 patients were included: 202 in the FNA group and 186 in the SLNB group. The FNA group had a significantly higher number of positive ALN (5.18 vs. 1.77, P < 0.001) and a larger proportion of patients with ≥ 3 ALN metastasis (58.42% vs. 11.83%, P < 0.001) than the SLNB group, which was not influenced by different tumor size stage and molecular subtypes. ALN metastasis identified by FNA was independently associated with a high rate of ≥ 3 ALN metastasis (OR = 6.98, 95% CI 1.95-25.02, P = 0.003).
Patients with positive preoperative ALN biopsy had a higher ALN metastasis burden than patients with 1-2 positive SLNs, which was also the strongest factor associated with ≥ 3 ALN metastasis, indicating that these patients are not appropriate to receive SLNB in the post-ACOSOG Z0011 trial era.
在超声检查怀疑腋窝淋巴结（ALN）转移且细针抽吸活检（FNA）阳性的乳腺癌患者中，需要进行 ALN 清扫（ALND），但在 ACOSOG Z0011 时代，这并不确定。我们旨在评估这些患者的 ALN 转移负荷，从而说明他们是否可以遵循 ACOSOG Z0011 试验方案。
回顾性分析临床 T1-2N0 期乳腺癌患者，术前 ALN 活检阳性（FNA 组）或 1-2 枚前哨淋巴结（SLNB）阳性（SLNB 组）。比较两组患者的 ALN 转移负荷，并对特定亚型进行进一步分析。还分析了临床病理因素与≥3 枚 ALN 转移的相关性。
共纳入 388 例患者：FNA 组 202 例，SLNB 组 186 例。FNA 组 ALN 阳性数目明显多于 SLNB 组（5.18 比 1.77，P<0.001），≥3 枚 ALN 转移患者比例明显高于 SLNB 组（58.42%比 11.83%，P<0.001），且不受肿瘤大小分期和分子亚型的影响。FNA 识别的 ALN 转移与较高的≥3 枚 ALN 转移率独立相关（OR=6.98，95%CI 1.95-25.02，P=0.003）。
术前 ALN 活检阳性患者的 ALN 转移负荷高于 1-2 枚 SLN 阳性患者，且与≥3 枚 ALN 转移相关性最强，提示这些患者在 ACOSOG Z0011 试验后不适合接受 SLNB。
