Defer Antoine, Tessier Vincent, Haudebourg Juliette, Dejode Magali, Gosset Marie, Barranger Emmanuel, Delpech Yann
Centre Antoine-Lacassagne, département de chirurgie sénologique, onco-gynécologique et reconstruction, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
Centre Antoine-Lacassagne, département de chirurgie sénologique, onco-gynécologique et reconstruction, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
Bull Cancer. 2021 Jun;108(6):605-613. doi: 10.1016/j.bulcan.2021.02.010. Epub 2021 May 8.
Invasive breast cancer without clinical adenopathy (cN0) is currently explored by the sentinel node (GS) technique, except in the case of positive preoperative radio-cytological screening, where axillary curage (CA) remains systematic from the outset. Since the publication of the ACOSOG-Z0011 trial, abstention from CA is possible in patients presenting less than three metastatic GS. As a result, the value of axillary radio-cytological screening is being questioned as it could potentially lead to axillary surgical over-treatment. The objective of this study was to study clinically N0 patients with positive axillary cytology and to compare it to a group of patients with positive GS.
One hundred and forty-seven patients with cN0 pN+ breast cancer treated between 2014 and 2016 were selected retrospectively. Two groups were constituted according to the initial radio-cytological evaluation. A CA was systematically performed.
Thirty-one patients with positive axillary cytology (n=31 vs. n=116) had more metastatic lymph nodes (P=0.01) in the AC, larger (P<0.001), less differentiated (P<0.001) tumours, and shorter recurrence-free survival (P=0.0114). It also appeared that 38.7 % of patients with a positive cytology had at most two metastatic nodes and could, according to the results of ACOSOG, benefit from therapeutic de-escalation.
X-ray cytological screening remains essential in order to select a subgroup of patients with a high lymph node tumour load. Additional studies are necessary in order to be able to offer therapeutic de-escalation to 1/3 of these patients without the risk of under-treatment for the remaining 2/3.
目前，对于无临床淋巴结肿大（cN0）的浸润性乳腺癌，采用前哨淋巴结（GS）技术进行探查，除非术前放射性细胞学筛查呈阳性，在这种情况下，腋窝清扫（CA）从一开始就是常规操作。自美国外科医师学会肿瘤学组（ACOSOG）-Z0011试验发表以来，对于转移的前哨淋巴结少于三个的患者，可以不进行腋窝清扫。因此，腋窝放射性细胞学筛查的价值受到质疑，因为它可能会导致腋窝手术过度治疗。本研究的目的是研究临床N0且腋窝细胞学检查呈阳性的患者，并将其与前哨淋巴结阳性的患者组进行比较。
回顾性选择2014年至2016年间接受治疗的147例cN0 pN +乳腺癌患者。根据初始放射性细胞学评估分为两组。均系统性地进行了腋窝清扫。
31例腋窝细胞学检查呈阳性的患者（n = 31对n = 116）在腋窝清扫中有更多的转移淋巴结（P = 0.01），肿瘤更大（P <0.001），分化程度更低（P <0.001），无复发生存期更短（P = 0.0114）。此外，细胞学检查呈阳性的患者中有38.7%最多有两个转移淋巴结，根据ACOSOG的结果，这些患者可能从治疗降级中获益。
为了选择一组淋巴结肿瘤负荷高的患者，放射性细胞学筛查仍然至关重要。需要进行更多研究，以便能够为这些患者中的三分之一提供治疗降级，同时不会给其余三分之二的患者带来治疗不足的风险。
