Maráz Róbert, Venczel László, Sikorszki László, Ambrózay Éva, Serfőző Orsolya, Rajtár Mária, Cserni Gábor
Általános Sebészeti Osztály,Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza6000 Kecskemét, Nyíri út 38.
Onkoradiológiai Központ,Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar OktatókórházaKecskemét.
Magy Seb. 2020 Mar;73(1):16-22. doi: 10.1556/1046.73.2020.1.2.
Introduction: The introduction of sentinel node biopsy (SNB) has led to a significant decrease of axillary lymph node dissections (ALND). The importance of the extracapsular extension (ECE) in the sentinel lymph node (SN) remains unclear. Method: The data of 635 patients with T1-T2N0M0 invasive breast cancer who underwent SNB between 2014 and 2018 were retrospectively analysed. 25% of the SNB patients (158) had metastasis in the SNs. These patients were grouped based on the presence or absence of ECE. The main objective of our study was to analyse the occurrence of massive (>3) node metastasis in the case of ECE negative and ECE positive patients, where ALND was performed. Results: There were 91/158 patients (58%) in the ECE negative group and 67/158 patients (42%) in the ECE positive group. ALND was performed in 42% of the ECE negative and in 69% of the ECE positive patients. There were no significant differences in the mean age of the patients; size, histological type and grade of the tumours, presence of lymphovascular invasion and proportion of hormone and HER2 receptor positivities. In the ECE negative ALND group, pN1 involvement was 82%, pN2+pN3 involvement represented 18% of cases. In the ECE positive ALND group, pN1 involvement was 60%, pN2+pN3 involvement was found in 40% of cases. The presence of ECE was associated with greater axillary disease burden. These results show a significant difference ( = 0.038). Conclusions: ECE of the SN is an important predictor for non-sentinel lymph node involvement. These data suggest, when ECE is confirmed, it is a further factor to be considered in deciding about ALND.
前哨淋巴结活检（SNB）的引入显著减少了腋窝淋巴结清扫术（ALND）的实施。前哨淋巴结（SN）中包膜外扩展（ECE）的重要性仍不明确。方法：回顾性分析了2014年至2018年间接受SNB的635例T1 - T2N0M0浸润性乳腺癌患者的数据。25%的SNB患者（158例）前哨淋巴结有转移。这些患者根据是否存在ECE进行分组。我们研究的主要目的是分析在进行ALND的情况下，ECE阴性和ECE阳性患者中出现大量（>3个）淋巴结转移的情况。结果：ECE阴性组有91/158例患者（58%），ECE阳性组有67/158例患者（42%）。42%的ECE阴性患者和69%的ECE阳性患者进行了ALND。患者的平均年龄、肿瘤大小、组织学类型和分级、淋巴管侵犯情况以及激素和HER2受体阳性比例均无显著差异。在ECE阴性的ALND组中，pN1受累率为82%，pN2 + pN3受累占病例的18%。在ECE阳性的ALND组中，pN1受累率为60%，40%的病例发现有pN2 + pN3受累。ECE的存在与腋窝疾病负担加重相关。这些结果显示出显著差异（P = 0.038）。结论：SN的ECE是非前哨淋巴结受累的重要预测指标。这些数据表明，当ECE得到证实时，它是决定是否进行ALND时需进一步考虑的因素。
