Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2021 Oct;28(11):6060-6068. doi: 10.1245/s10434-021-09943-7. Epub 2021 Apr 19.
Axillary metastases in the form of palpable adenopathy indicate the need for neoadjuvant chemotherapy or axillary lymph node dissection (ALND). Patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) disease infrequently have nodal pathologic complete response to neoadjuvant chemotherapy and often require ALND. Sentinel lymph node biopsy is an accepted treatment for patients with two or fewer non-palpable nodal metastases who are undergoing breast conservation. The proportion of patients with HR+/HER2- disease with palpable adenopathy and two or fewer nodal metastases is unknown.
Patients with cT1-T3N1 HR+/HER2- disease with palpable adenopathy were identified from a prospective database. Patients who underwent mastectomy or breast-conserving therapy with ALND were included in this study, whereas patients who received neoadjuvant chemotherapy were excluded. Clinicopathologic characteristics were compared between patients with two or fewer or more than two positive nodes on ALND.
Of 180 patients included, 78 (43%) had two or fewer positive nodes on ALND, including 40/72 patients (56%) who underwent lumpectomy. On univariate analysis, cT1 tumor, unifocal tumor, only one palpable node, and two or fewer suspicious nodes on ultrasound were associated with two or fewer positive nodes on ALND. On multivariable analysis, number of suspicious nodes on ultrasound and cT stage were independently associated with two or fewer positive nodes on ALND.
A substantial minority of patients with cT1-3N1 HR+/HER2- disease with palpable adenopathy had two or fewer positive nodes on ALND. Standard clinicopathologic features and ultrasound findings can help identify candidates for upfront sentinel lymph node biopsy as a strategy to avoid ALND. Prospective studies evaluating this approach are warranted.
可触及的淋巴结转移表明需要新辅助化疗或腋窝淋巴结清扫（ALND）。激素受体阳性/人表皮生长因子受体 2 阴性（HR+/HER2-）疾病患者新辅助化疗后很少出现淋巴结病理完全缓解，通常需要 ALND。前哨淋巴结活检是接受保乳治疗且有两个或更少非触诊淋巴结转移的患者的一种可接受的治疗方法。HR+/HER2-疾病且有可触及的淋巴结转移和两个或更少淋巴结转移的患者比例尚不清楚。
从前瞻性数据库中确定了有可触及的淋巴结转移的 cT1-T3N1 HR+/HER2-疾病患者。本研究纳入接受了 ALND 的乳房切除术或保乳治疗的患者，而排除了接受新辅助化疗的患者。比较了 ALND 上有两个或更少或更多阳性淋巴结的患者的临床病理特征。
在纳入的 180 例患者中，78 例（43%）在 ALND 上有两个或更少的阳性淋巴结，其中 40/72 例（56%）接受了乳房肿瘤切除术。单因素分析显示，cT1 肿瘤、单灶肿瘤、只有一个可触及的淋巴结以及超声上有两个或更少可疑淋巴结与 ALND 上有两个或更少阳性淋巴结有关。多变量分析显示，超声上可疑淋巴结的数量和 cT 分期与 ALND 上有两个或更少阳性淋巴结独立相关。
有相当一部分有可触及的淋巴结转移的 cT1-3N1 HR+/HER2-疾病患者在 ALND 上有两个或更少的阳性淋巴结。标准的临床病理特征和超声表现有助于识别适合 upfront 前哨淋巴结活检的候选者，以避免 ALND。需要进行前瞻性研究来评估这种方法。
