在乳腺手术中，通过使用 MammaPrint 对核心针活检进行指导，以确定是否需要进行腋窝分期。

Using MammaPrint on core needle biopsy to guide the need for axillary staging during breast surgery.

机构信息

Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH.

Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

出版信息

Surgery. 2024 Mar;175(3):579-586. doi: 10.1016/j.surg.2023.08.037. Epub 2023 Oct 17.

DOI:10.1016/j.surg.2023.08.037

PMID:37852835

Abstract

BACKGROUND

At present, the only opportunity to omit axillary staging is with Choosing Wisely criteria for women ages >70 y with cT1 2N0 estrogen receptor-positive/human epidermal growth factor receptor 2-negative breast cancer. However, many women are diagnosed when pathologic node status-negative, raising the question of additional opportunities to omit sentinel lymph node biopsy. We sought to investigate the association between MammaPrint, a genomic test that estimates estrogen receptor-positive breast cancer recurrence risk, and pathologic node status, with the aim that low-risk MammaPrint could be considered for omission of sentinel lymph node biopsy if associated with pathologic node status-negative.

METHODS

A single-institution database was queried for all women with cT1 2N0 estrogen receptor-positive/human epidermal growth factor receptor 2-negative invasive breast cancer with breast surgery as their first treatment and MammaPrint performed from 2020 to 2021. Patient and tumor factors, including MammaPrint score, were compared with axillary node status for correlation.

RESULTS

A total of 668 women met inclusion criteria, with a median age of 66 y. MammaPrint was low-risk luminal A in 481 (72%) and high-risk luminal B in 187 (28%). At the time of breast surgery, 588 (88%) had sentinel lymph node biopsy, 27 (4%) had axillary lymph node dissection, and 53 (7.9%) had no axillary staging. Most women in both the pathologic node status-negative and pathologic node status-positive cohorts had low-risk MammaPrint (355 [73.3%] pathologic node status-negative vs 91 [69.5%] pathologic node status-positive), and women with low-risk MammaPrint did not have a significantly lower risk of pathologic node status-positive (P = .377).

CONCLUSION

Low-risk MammaPrint does not predict lower risk of pathologic node status-positive breast cancer. Based on our results, genomic testing does not appear to provide additional personalization for the ability to omit sentinel lymph node biopsy for patients outside of the Choosing Wisely guidelines.

摘要

背景

目前，免除腋窝分期的唯一机会是符合选择明智标准的年龄>70 岁的 cT1 2N0 雌激素受体阳性/人表皮生长因子受体 2 阴性乳腺癌女性。然而，许多女性在病理淋巴结阴性时被诊断出来，这就提出了是否有其他机会省略前哨淋巴结活检的问题。我们试图研究 MammaPrint 与病理淋巴结状态之间的关系，MammaPrint 是一种估计雌激素受体阳性乳腺癌复发风险的基因组检测，目的是如果 MammaPrint 结果低危且与病理淋巴结状态阴性相关，则可以考虑省略前哨淋巴结活检。

方法

对 2020 年至 2021 年期间接受乳房手术作为初始治疗且进行了 MammaPrint 检测的 cT1 2N0 雌激素受体阳性/人表皮生长因子受体 2 阴性浸润性乳腺癌的单机构数据库进行了查询。比较了患者和肿瘤因素，包括 MammaPrint 评分，与腋窝淋巴结状态的相关性。

结果

共有 668 名女性符合纳入标准，中位年龄为 66 岁。MammaPrint 检测结果为低危 luminal A 型的有 481 例（72%），高危 luminal B 型的有 187 例（28%）。在乳房手术时，588 例（88%）进行了前哨淋巴结活检，27 例（4%）进行了腋窝淋巴结清扫，53 例（7.9%）未进行腋窝分期。在病理淋巴结状态阴性和阳性两组中，大多数女性的 MammaPrint 检测结果为低危（355 例[73.3%]为病理淋巴结状态阴性，91 例[69.5%]为病理淋巴结状态阳性），且低危 MammaPrint 组的病理淋巴结状态阳性风险无显著降低（P=0.377）。