腋窝清扫术在有症状乳腺癌前哨淋巴结活检阳性后的应用。
Axillary Clearance Following Positive Sentinel Lymph Node Biopsy in Symptomatic Breast Cancer.
机构信息
Department of Breast Surgery, Pennine Acute Hospitals NHS Trust, Manchester, U.K.
出版信息
In Vivo. 2020 Nov-Dec;34(6):3503-3509. doi: 10.21873/invivo.12191.
BACKGROUND/AIM: Symptomatic cancers display a different biological behaviour from screen-detected cancers, which may impact the management of axillary metastases. We aimed to determine the role of unselected axillary nodal clearance (ANC) in symptomatic patients with positive sentinel node biopsies (SNBs).
PATIENTS AND METHODS
A case-note review was performed on 95 symptomatic breast cancer patients who underwent ANC following positive SNB.
RESULTS
Thirty-eight (40%) patients were treated with a mastectomy and 57 (60%) with breast-conserving surgery. At ANC, 25 patients (26.3%) showed evidence of further lymph node metastases, with 15 (60%) having two or fewer macrometastases. The presence of more than 2 SNB macrometastases was associated with further ANC metastases (p<0.001). The presence of further metastases at ANC was not associated with either reduced overall survival or disease-free survival.
CONCLUSION
A number of symptomatic breast cancer patients with positive SNBs may be overtreated. Ongoing trials examining the management of low volume SNB macrometastases need to consider the symptomatic subgroup in their conclusions.
背景/目的：有症状的癌症表现出与筛查检测到的癌症不同的生物学行为，这可能会影响腋窝转移的管理。我们旨在确定在阳性前哨淋巴结活检 (SNB) 的有症状患者中，非选择性腋窝淋巴结清扫术 (ANC) 的作用。
患者和方法
对 95 例接受 ANC 治疗的阳性 SNB 后有症状的乳腺癌患者进行了病例回顾。
结果
38 例（40%）患者接受了乳房切除术，57 例（60%）患者接受了保乳手术。在 ANC 时，25 例（26.3%）显示出进一步淋巴结转移的证据，其中 15 例（60%）有两个或更少的大转移灶。SNB 大转移灶超过 2 个与 ANC 转移更多相关（p<0.001）。ANC 中存在更多转移与总生存率或无病生存率降低无关。
结论
许多有阳性 SNB 的有症状乳腺癌患者可能接受了过度治疗。正在进行的检查低体积 SNB 大转移灶管理的试验需要在其结论中考虑症状亚组。
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