Parmar Vani, Nair Nita S, Vanmali Vaibhav, Hawaldar Rohini W, Siddique Shabina, Shet Tanuja, Desai Sangeeta, Rangarajan Venkatesh, Patil Asawari, Gupta Sudeep, Badwe Rajendra A
Department of Breast Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Breast Cancer Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
JCO Glob Oncol. 2020 Oct;6:1546-1553. doi: 10.1200/GO.20.00246.
We tested low axillary sampling (LAS) and sentinel node biopsy (SNB) performed in the same patient to predict axillary nodal status post-neoadjuvant chemotherapy (NACT) in women undergoing elective breast surgery, clinically N0 after NACT.
A total of 751 women clinically node negative post-NACT underwent LAS (excision of lymph node [LN] and fat below first intercostobrachial nerve). Of these women, 730 also underwent SNB by dual technique (methylene blue plus radioisotope). SNB (defined as targeted plus palpable LNs) and LAS specimens were distinctly examined for metastasis. All patients underwent completion axillary lymph node dissection. Post-NACT, 290 (38.6%) of 751 women had residual positive lymph nodes on pathology.
The median clinical tumor size was 5 cm (range, 1-15 cm), and 533 (71%) of patients were N1 or N2 at presentation. Targeted sentinel node (SN) identification was 85.7% (626 of 730; median, two LNs); SN with palpable nodes was found in 95.2% (695 of 730; median, five LNs); LAS node was identified in 98.5% (740 of 751; median, seven LNs). In all but one case, the SN was found within the LAS specimen. The false negative rate (FNR) of SNB (blue, hot, and adjacent palpable nodes) was 19.7% (47 of 238; one-sided 95% CI upper limit, 24.0), compared with an FNR of 9.9% for LAS (29 of 292; one-sided 95% CI upper limit, 12.8; < .001). If SNB was confined to blue/hot node, excluding adjacent palpable nodes, the FNR was 31.6% (74 of 234; one-sided 95% CI upper limit, 36.6). The FNR could be brought down to < 8.8% if three or more LNs were identified by LAS.
LAS is superior to SNB in identification rate, FNR, and negative predictive value in predicting node-negative axilla post-NACT. LAS can be safely used to predict negative axilla with < 10% chance of leaving residual disease.
我们对同一患者进行低位腋窝取样（LAS）和前哨淋巴结活检（SNB），以预测接受择期乳房手术且新辅助化疗（NACT）后临床N0的女性患者NACT后的腋窝淋巴结状态。
共有751例NACT后临床淋巴结阴性的女性接受了LAS（切除第一肋间臂神经下方的淋巴结[LN]和脂肪）。在这些女性中，730例还通过双重技术（亚甲蓝加放射性同位素）进行了SNB。分别检查SNB（定义为靶向及可触及的LN）和LAS标本有无转移。所有患者均接受了腋窝淋巴结清扫术。NACT后，751例女性中有290例（38.6%）病理检查发现残留阳性淋巴结。
临床肿瘤大小中位数为5 cm（范围1 - 15 cm），533例（71%）患者初诊时为N1或N2。靶向前哨淋巴结（SN）识别率为85.7%（730例中的626例；中位数为2个LN）；可触及淋巴结的SN发现率为95.2%（730例中的695例；中位数为5个LN）；LAS淋巴结识别率为98.5%（751例中的740例；中位数为7个LN）。除1例病例外，所有SN均在LAS标本中发现。SNB（蓝色、热区及相邻可触及淋巴结）的假阴性率（FNR）为19.7%（238例中的47例；单侧95%CI上限为24.0），而LAS的FNR为9.9%（292例中的29例；单侧95%CI上限为12.8；P <.001）。如果SNB仅限于蓝色/热区淋巴结，不包括相邻可触及淋巴结，FNR为31.6%（234例中的74例；单侧95%CI上限为36.6）。如果LAS识别出三个或更多LN，FNR可降至< 8.8%。
在预测NACT后腋窝淋巴结阴性方面，LAS在识别率、FNR和阴性预测值方面优于SNB。LAS可安全用于预测腋窝阴性，残留疾病几率< 10%。
