Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan.
Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan.
Breast Cancer. 2021 Sep;28(5):1016-1022. doi: 10.1007/s12282-021-01236-x. Epub 2021 Mar 19.
This study aimed to assess the clinical effect of the pathological axillary assessment method in breast cancer without clinical lymph node metastasis.
Data of patients with clinically node-negative breast cancer were retrospectively reviewed. The study period was divided into early (January 2000-July 2007) and late (August 2007-December 2014) periods based on the pathological assessment method used (single-sectional and detailed multi-sectional lymph node processing). In the late period, lymph nodes were evaluated at six levels including immunohistochemistry on each 1.5-2 mm interval section. The axillary diagnostic accuracy and role of chemotherapy were assessed.
In 1698 patients, 27 isolated tumor cells (ITCs), 39 micrometastases, and 205 macrometastases were noted. The sensitivity for pathological N0 diagnosis was dependent on clinical T stage, Tis (97.8%), T1 (83.0%), T2 (74.2%), T3 (54.5%), and T4 (63.6%). ITCs and micrometastases were detected only in the late period, and 84.7% and 91.6% of cases in the early and late period, respectively, did not have macrometastases. The 5-year disease-free interval (DFI) rates were 95.2% in node-negative cases, 98.4% in ITCs/micrometastases, and 91.4% in macrometastases (P < 0.001). In multivariate analysis, the predictor for DFI was estrogen receptor negativity (P = 0.013). Chemotherapy did not improve DFI in patients with node-positive breast cancer.
The detailed multi-sectional pathological assessment of axillary lymph nodes detected ITCs and micrometastases. Implementation of chemotherapy should not be based on the minimal nodal metastasis and this type of serially nodal sectioned processing had little clinical significance.
本研究旨在评估无临床淋巴结转移的乳腺癌患者的病理性腋窝评估方法的临床效果。
回顾性分析临床淋巴结阴性乳腺癌患者的数据。根据使用的病理评估方法（单节段和详细的多节段淋巴结处理）将研究期间分为早期（2000 年 1 月至 2007 年 7 月）和晚期（2007 年 8 月至 2014 年 12 月）。在晚期，对每 1.5-2mm 间隔的切片进行免疫组织化学评估，共评估 6 个水平的淋巴结。评估腋窝诊断的准确性和化疗的作用。
在 1698 例患者中，发现 27 例孤立肿瘤细胞（ITC）、39 例微转移和 205 例巨转移。病理性 N0 诊断的敏感性取决于临床 T 分期，Tis（97.8%）、T1（83.0%）、T2（74.2%）、T3（54.5%）和 T4（63.6%）。ITC 和微转移仅在晚期发现，早期和晚期分别有 84.7%和 91.6%的病例没有巨转移。淋巴结阴性病例的 5 年无病间隔（DFI）率为 95.2%，ITC/微转移为 98.4%，巨转移为 91.4%（P<0.001）。多因素分析显示，DFI 的预测因子为雌激素受体阴性（P=0.013）。化疗不能改善淋巴结阳性乳腺癌患者的 DFI。
腋窝淋巴结的详细多节段病理评估检测到 ITC 和微转移。化疗的实施不应基于最小的淋巴结转移，这种连续淋巴结切片处理方式在临床上意义不大。
