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. 2022 Oct;29(10):6133-6139. doi: 10.1245/s10434-022-12240-6. Epub 2022 Jul 28.
BACKGROUND: In cN1 patients rendered cN0 with neoadjuvant chemotherapy, the false-negative rate of sentinel lymph node biopsy (SLNB) is < 10% when ≥ 3 sentinel lymph nodes (SLNs) are removed. The added value of nodal clipping in this scenario is unknown. Here we determine how often the clipped node is a sentinel node when ≥ 3 SLNs are retrieved. METHODS: We identified cT1-3N1 patients treated between 02/2018 and 10/2021 with a clipped lymph node at presentation. SLNB was performed with a standardized approach of dual-tracer mapping and retrieval of ≥ 3 SLNs. Clipped nodes were not localized; SLNs were X-rayed intraoperatively to determine clip location. Axillary lymph node dissection (ALND) was performed for any residual disease or retrieval of < 3 SLNs. RESULTS: Of 269 patients, 251 (93%) had ≥ 3 SLNs. Median age was 51 years; the majority (92%) had ductal histology; 46% were HR+/HER2-. The median number of SLNs removed was 4 (IQR 3,5). The clipped node was an SLN in 88% (220/251) of cases. Of the 31 where the clipped node was not, 13 had a positive SLN mandating ALND, and the clip was identified in the ALND specimen. In the remaining 18, where ≥ 3 negative SLNs were retrieved and an ALND was not performed, the clip was not retrieved, with no axillary failures in this group (median follow-up: 55 months). CONCLUSION: When the SLNB procedure is optimized with dual tracer and retrieval of ≥ 3 SLNs, the clipped node is an SLN in the majority of cases, suggesting that failure to retrieve the clipped node should not be an indication for ALND.
背景：在接受新辅助化疗后 cN1 患者的 cN0 中，当切除≥3 个前哨淋巴结 (SLN) 时，SLNB 的假阴性率<10%。在这种情况下，淋巴结夹闭的附加价值尚不清楚。在此，我们确定当切除≥3 个 SLN 时，夹闭的淋巴结有多少是前哨淋巴结。
方法：我们确定了 2018 年 2 月至 2021 年 10 月间就诊时存在夹闭淋巴结的 cT1-3N1 患者。SLNB 采用双示踪剂映射和切除≥3 个 SLN 的标准化方法进行。夹闭的淋巴结未定位；SLN 在术中进行 X 射线检查以确定夹的位置。对于任何残留疾病或未切除≥3 个 SLN ，进行腋窝淋巴结清扫术 (ALND)。
结果：在 269 例患者中，251 例（93%）有≥3 个 SLN。中位年龄为 51 岁；大多数（92%）为导管组织学；46%为 HR+/HER2-。切除的 SLN 中位数为 4 个（IQR 3，5）。夹闭的淋巴结在 220/251 例（88%）病例中为 SLN。在 31 例夹闭的淋巴结未为 SLN 的病例中，13 例 SLN 阳性需要 ALND，夹在 ALND 标本中被识别。在其余 18 例中，切除≥3 个阴性 SLN 且未进行 ALND 的病例中，未取出夹，该组无腋窝复发（中位随访：55 个月）。
结论：当 SLNB 程序通过双示踪剂和切除≥3 个 SLN 进行优化时，夹闭的淋巴结在大多数情况下是 SLN，这表明未能取出夹闭的淋巴结不应成为 ALND 的指征。
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