确定早期乳腺癌患者的高淋巴结负荷是否可在术前预测，以避免前哨淋巴结活检。
Determining Whether High Nodal Burden in Early Breast Cancer Patients Can Be Predicted Preoperatively to Avoid Sentinel Lymph Node Biopsy.
作者信息
Lim Geok Hoon, Teo Sze Yiun, Allen John Carson, Chinthala Jubal Pallavi, Leong Lester Chee Hao
机构信息
Breast Department, KK Women's and Children's Hospital, Singapore.
Duke-NUS Medical School, Singapore.
出版信息
J Breast Cancer. 2019 Mar;22(1):67-76. doi: 10.4048/jbc.2019.22.e8.
PURPOSE
The Z0011 trial showed that axillary lymph node dissection (ALND) can be safely avoided in breast cancer patients with low nodal burden (LNB). ALND can be performed in patients with high nodal burden (HNB). We aimed to determine whether HNB in early breast cancer patients can be predicted preoperatively to avoid sentinel lymph node biopsy (SLNB).
METHODS
Early invasive breast cancer patients (cT1-2cN0) were retrospectively reviewed. We excluded patients with neoadjuvant chemotherapy and incomplete data. The patients were divided into the following groups based on surgical histology: no positive (N0), LNB, and HNB, defined as 0, 1-2, and ≥ 3 metastatic lymph nodes (LNs), respectively. Of the patients with metastatic nodal disease, only those with ALND were included in the analysis. Clinical, radiological, and histological parameters were evaluated using logistic regression analysis as predictors of HNB versus LNB and N0 combined.
RESULTS
Of the 1,298 included patients, 832 (64.1%), 286 (22.0%), and 180 (13.9%) had N0, LNB, and HNB, respectively. Univariate logistic regression analysis revealed that sonographic features of breast tumor size ( < 0.0001), number of abnormal LNs ( < 0.0001), cortical thickness ( = 0.0002), effacement of the fatty hilum ( < 0.0001), and needle biopsy being performed ( < 0.0001) were indicators of HNB. Breast tumor grade ( = 0.0001) and human epidermal growth factor receptor 2 status ( = 0.0262) were also statistically significant. Among these significant features, multivariable stepwise logistic regression showed that the number of abnormal LNs is the sole independent predictor of HNB ( < 0.0001, area under the curve = 0.774). The positive predictive value of HNB in patients with ≥ 4 abnormal LNs was 92.9%.
CONCLUSION
The detection of ≥ 4 abnormal LNs on ultrasound can help to identify HNB patients who require upfront ALND and thus avoid SLNB.
目的
Z0011试验表明，淋巴结负荷低（LNB）的乳腺癌患者可安全避免腋窝淋巴结清扫（ALND）。淋巴结负荷高（HNB）的患者可进行ALND。我们旨在确定早期乳腺癌患者的HNB是否可在术前预测，以避免前哨淋巴结活检（SLNB）。
方法
对早期浸润性乳腺癌患者（cT1-2cN0）进行回顾性分析。我们排除了接受新辅助化疗和数据不完整的患者。根据手术组织学将患者分为以下几组：无转移（N0）、LNB和HNB，分别定义为转移淋巴结（LN）数为0、1-2和≥3个。在有转移性淋巴结疾病的患者中，仅将接受ALND的患者纳入分析。使用逻辑回归分析评估临床、放射学和组织学参数，作为HNB与LNB和N0合并组的预测指标。
结果
在纳入的1298例患者中，分别有832例（64.1%）、286例（22.0%）和180例（13.9%）为N0、LNB和HNB。单因素逻辑回归分析显示，乳腺肿瘤大小的超声特征（<0.0001）、异常LN数量（<0.0001）、皮质厚度（=0.0002）、脂肪门消失（<0.0001）以及是否进行了穿刺活检（<0.0001）是HNB的指标。乳腺肿瘤分级（=0.0001）和人表皮生长因子受体2状态（=0.0262）也具有统计学意义。在这些显著特征中，多变量逐步逻辑回归显示，异常LN数量是HNB的唯一独立预测指标（<0.0001，曲线下面积=0.774）。LN异常数≥4的患者中HNB的阳性预测值为92.9%。
结论
超声检测到≥4个异常LN有助于识别需要直接进行ALND从而避免SLNB的HNB患者。
Zotero 插件