Head and Department of Surgical Oncology, Ludwik Rydygier's Collegium Medicum UMK, Bydgoszcz, Poland.
Department of Clinical Breast Cancer and Reconstructive Surgery, Oncology Centre, Bydgoszcz, Poland.
Breast J. 2020 May;26(5):873-881. doi: 10.1111/tbj.13769. Epub 2020 Jan 30.
Sentinel lymph node biopsy (SLNB) is a standard in diagnostic and therapeutic management of patients with nonadvanced invasive breast cancer. The aim of this paper was to evaluate the clinical importance of the failure of sentinel lymph node (SLN) identification during SLNB performed to spare axillary lymph nodes. A total of 5396 patients with invasive breast cancer qualified for SLNB, treated in a period from Jan 2004 to June 2018. All cases of the failure of SLN identification and reasons underlying this situation were analyzed retrospectively. In 196 (3.6%) patients, SLN was not identified (group I), and this resulted in a simultaneous axillary lymph node dissection. 48.5% patients from this group were diagnosed with cancer metastases to lymph nodes (vs 23.6% patients with SLN removed-group II, P < .00001)-stage pN1 in 44.2% of the cases, stage pN2 in 22.1% of the cases, and pN3 in 33.7% (in group II-73.4%, 19.5% and 7.1%, respectively), with a presence of extracapsular infiltration in 68.4% patients (vs 41.7% in group II) and with a significantly higher percentage of micrometastatic nature in group II (17.0%, vs 3.2% in group I). The failure of intraoperative sentinel lymph node mapping indicates a significantly increased risk of breast cancer metastases to the axillary lymph system. At the same time, it can also indicate higher cancer stage and its increased aggressiveness. For this reason, in such situation performance of axillary lymph node dissection still appears to be the approach most advantageous for patients.
前哨淋巴结活检（SLNB）是诊断和治疗非晚期浸润性乳腺癌患者的标准方法。本文旨在评估在避免腋窝淋巴结清扫的情况下，SLNB 中前哨淋巴结（SLN）识别失败的临床重要性。共有 5396 例浸润性乳腺癌患者符合 SLNB 条件，治疗时间为 2004 年 1 月至 2018 年 6 月。回顾性分析所有 SLN 识别失败的病例及其原因。在 196 例（3.6%）患者中，未识别出 SLN（组 I），这导致同时进行腋窝淋巴结清扫。该组 48.5%的患者被诊断为淋巴结转移癌（与 SLN 切除组 II 相比，23.6%，P<.00001）-44.2%的病例为 pN1 期，22.1%的病例为 pN2 期，33.7%的病例为 pN3 期（在组 II 中分别为 73.4%、19.5%和 7.1%），68.4%的患者存在包膜外浸润（与组 II 中的 41.7%相比），组 II 中微转移的比例明显更高（17.0%，与组 I 中的 3.2%相比）。术中前哨淋巴结绘图失败表明乳腺癌转移至腋窝淋巴结系统的风险显著增加。同时，也可能表明癌症分期更高，侵袭性更强。出于这个原因，在这种情况下，进行腋窝淋巴结清扫仍然是对患者最有利的方法。
