General Surgery Department, Morales Meseguer University Hospital, Murcia, Spain; University of Murcia, Faculty of Medicine, IMIB-Arrixaca, "Mare Nostrum" International Excellence Campus, Murcia, Spain.
General Surgery Department, Morales Meseguer University Hospital, Murcia, Spain; University of Murcia, Faculty of Medicine, IMIB-Arrixaca, "Mare Nostrum" International Excellence Campus, Murcia, Spain.
Surg Oncol. 2021 Sep;38:101636. doi: 10.1016/j.suronc.2021.101636. Epub 2021 Jul 21.
to study the feasibility and value of "Targeted Axillary Dissection" (TAD) in cN1 breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NACT), in order to avoid unnecessary axillary lymph node dissection (ALND).
Design: Prospective observational study.
Patients with histologically confirmed cN1 staging BC and treated with NACT between January 2016 and August 2019 who accomplished clinical response.
Fine-Needle Aspiration (FNA) positive axillary nodes were marked with a metallic clip prior to neoadjuvant treatment. All patients were summited to TAD and ALND. Analysis of data: We performed [1]: a feasibility analysis of clinical, radiological and pathological variables, as well as difficulties and complications of the TAD [2]; a diagnostic test study of the sentinel lymph node biopsy (SLNB), clipped lymph node biopsy (BCLIP) and their combination (TAD), using ALND as the Gold Standard.
60 patients were included. 43 patients (71.7%) had a complete clinical lymph node response to NACT. Neither limitations nor complications in clip placement were found. Intraoperative location of the clipped node was problematic in 7 cases (11.7%). The pathological complete response rate (pCR) was 30.5% (18 patients) and ypN0 staging rate was 38.3% (23 patients). Sensitivity values of each technique were: SLNB: 80.9% (95%CI: 61.8-100); BCLIP: 80.8% (95%CI: 63.7-97.8); TAD: 92.6% (95%CI: 80.9-100) with negative predictive values of: SLNB: 84.6% (95%CI: 68.8-100); BCLIP: 81.0% (95%CI: 63.7-97.8); TAD: 91.3% (95%CI: 77.6-100).
TAD is feasible and valid to rule out axillary metastatic involvement in cN1 breast cancer patients who respond to NACT.
研究新辅助化疗（NACT）后 cN1 期乳腺癌（BC）患者行“靶向腋窝解剖”（TAD）的可行性和价值，以避免不必要的腋窝淋巴结清扫（ALND）。
设计：前瞻性观察性研究。
2016 年 1 月至 2019 年 8 月期间接受 NACT 且临床应答的组织学证实 cN1 分期 BC 患者。
在新辅助治疗前，用细针抽吸（FNA）阳性腋窝淋巴结标记金属夹。所有患者均接受 TAD 和 ALND。数据分析：我们进行了[1]：临床、影像学和病理学变量的可行性分析，以及 TAD 的难度和并发症分析[2]；使用 ALND 作为金标准，对前哨淋巴结活检（SLNB）、夹闭淋巴结活检（BCLIP）及其联合（TAD）的诊断试验研究。
共纳入 60 例患者。43 例（71.7%）患者对 NACT 有完全的临床淋巴结反应。未发现夹放置的局限性或并发症。7 例（11.7%）术中夹闭淋巴结定位困难。病理完全缓解率（pCR）为 30.5%（18 例），ypN0 分期率为 38.3%（23 例）。各技术的敏感性值为：SLNB：80.9%（95%CI：61.8-100）；BCLIP：80.8%（95%CI：63.7-97.8）；TAD：92.6%（95%CI：80.9-100），阴性预测值分别为：SLNB：84.6%（95%CI：68.8-100）；BCLIP：81.0%（95%CI：63.7-97.8）；TAD：91.3%（95%CI：77.6-100）。
TAD 对于预测新辅助化疗后对 NACT 有反应的 cN1 期 BC 患者的腋窝转移受累是可行和有效的。
Zotero 插件