The Nightingale Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
National Health Service Breast Screening Programme, Public Health England, Birmingham, UK.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa022.
Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC.
Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC.
Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients.
This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.
在腋窝前哨淋巴结活检（SLNB）中发现存在宏转移的经筛检发现的浸润性乳腺癌女性，通常会接受腋窝淋巴结清扫术（ANC）或腋窝放疗。这些治疗会给患者带来严重的并发症。本研究旨在确定一组可能不需要完成 ANC 的患者。
对 2012 年 4 月 1 日至 2017 年 3 月 31 日期间 NHS 乳腺筛查计划的数据进行了查询，以确定患有浸润性乳腺癌且单个前哨淋巴结（SLN）存在宏转移并随后接受 ANC 的女性。进行了单变量和多变量分析，以确定在 ANC 中无进一步淋巴结转移的单个阳性 SLN 患者。
在该队列的 2401 名女性中，非前哨淋巴结疾病的存在显著受以下因素影响：SLNB 中获得的淋巴结数量（检出 1 个以上淋巴结的比值比 (OR) 为 0.49）、肿瘤浸润大小（大小大于 20mm 的 OR 为 1.63）、手术治疗（乳房切除术的 OR 为 1.34）、人类表皮生长因子受体（HER）2 状态（HER2 阳性的 OR 为 0.71）和患者年龄（年龄小于 50 岁的 OR 为 1.10；年龄大于 70 岁的 OR 为 1.46）。年龄小于 70 岁、肿瘤大小小于 2cm、SLNB 中检出 1 个以上淋巴结且接受保乳手术的患者，与其他患者相比，在 ANC 中发现非前哨淋巴结阳性的可能性较低。
本研究为一项单纯的筛检发现乳腺癌队列研究，确定了一组患者，在 SLN 存在宏转移的情况下，可能无需进行 ANC。
