Zhang Juliang, Ling Yuwei, Wang Ting, Yan Changjiao, Huang Meiling, Fan Zhimin, Ling Rui
Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Oct;9(20):1588. doi: 10.21037/atm-21-5169.
Information regarding the implementation of sentinel lymph node biopsy (SLNB) in invasive lobular carcinoma (ILC) is scarce, and whether ILC patients with 1-2 positive sentinel lymph nodes (SLNs) can be omitted from axillary lymph node dissection (ALND) remains controversial. This study aimed to compare involvement of SLNs and non-SLNs between patients with invasive ductal carcinoma (IDC) and ILC.
We retrospectively collected the clinical and pathological data of invasive breast cancer patients from 37 medical centers in China from January 2018 to December 2018. The number of resected SLNs, positive rate of SLNs, and non-SLNs metastasis were compared between patients with IDC and ILC.
A total of 6,922 patients were included, comprising 6,650 with IDC (96.1%) and 272 with ILC (3.9%). No difference was observed in the number of resected SLNs between patients with IDC and ILC (IDC: 4.0±1.9 ILC: 3.9±1.6, P=0.352). The positive rate of SLNs was significantly higher in patients with IDC than that in patients with ILC (19.3% in IDC . 12.9% in ILC, P=0.008). The difference in positive rate of SLNs between IDC and ILC was mainly attributed to macro-metastasis. For patients with positive SLNs who received ALND, and those with 1-2 positive SLNs, the metastatic rate of non-SLNs in the ILC group was higher than that in the IDC group (for patients with positive SLNs: 50.0% in ILC . 39.9% in IDC, P=0.317; for patients with 1-2 positive SLNs: 45.4% in ILC . 34.8% in IDC, P=0.366), but the differences were not statistically significant.
Patients with ILC had similar number of resected SLNs and lower positive rate of SLNs compared to those with IDC. In participants with 1-2 positive SLNs, the ILC group had an increased tendency for non-SLNs metastasis compared with the IDC group. Surgeons may need to be more cautious about omitting ALND for ILC patients with 1-2 positive SLNs.
关于前哨淋巴结活检（SLNB）在浸润性小叶癌（ILC）中的应用信息匮乏，且ILC患者前哨淋巴结（SLN）有1 - 2枚阳性时能否省略腋窝淋巴结清扫（ALND）仍存在争议。本研究旨在比较浸润性导管癌（IDC）和ILC患者SLN和非SLN的受累情况。
我们回顾性收集了2018年1月至2018年12月期间来自中国37个医疗中心的浸润性乳腺癌患者的临床和病理数据。比较了IDC和ILC患者切除的SLN数量、SLN阳性率及非SLN转移情况。
共纳入6922例患者，其中IDC患者6650例（96.1%），ILC患者272例（3.9%）。IDC和ILC患者切除的SLN数量无差异（IDC：4.0±1.9；ILC：3.9±1.6，P = 0.352）。IDC患者的SLN阳性率显著高于ILC患者（IDC为19.3%，ILC为12.9%，P = 0.008）。IDC和ILC患者SLN阳性率的差异主要归因于宏观转移。对于接受ALND的SLN阳性患者以及SLN有1 - 2枚阳性的患者，ILC组非SLN的转移率高于IDC组（SLN阳性患者：ILC为50.0%，IDC为39.9%，P = 0. 317；SLN有1 - 2枚阳性患者：ILC为45.4%，IDC为34.8%，P = 0.366），但差异无统计学意义。
与IDC患者相比，ILC患者切除的SLN数量相似但SLN阳性率较低。在SLN有1 - 2枚阳性的参与者中，ILC组非SLN转移的倾向高于IDC组。对于SLN有1 - 2枚阳性的ILC患者，外科医生在省略ALND时可能需要更加谨慎。
