新辅助化疗后临床淋巴结阳性乳腺癌行靶向腋窝清扫术可减少残留淋巴结疾病。

Targeted axillary dissection reduces residual nodal disease in clinically node- positive breast cancer after neoadjuvant chemotherapy.

机构信息

Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye.

Department of Surgical Oncology, Istanbul University, Institute of Oncology, Istanbul, Türkiye.

出版信息

World J Surg Oncol. 2024 Jul 6;22(1):178. doi: 10.1186/s12957-024-03413-6.

DOI:10.1186/s12957-024-03413-6

PMID:38971793

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11227135/

Abstract

BACKGROUND

Any advantage of performing targeted axillary dissection (TAD) compared to sentinel lymph node (SLN) biopsy (SLNB) is under debate in clinically node-positive (cN+) patients diagnosed with breast cancer. Our objective was to assess the feasibility of the removal of the clipped node (RCN) with TAD or without imaging-guided localisation by SLNB to reduce the residual axillary disease in completion axillary lymph node dissection (cALND) in cN+ breast cancer.

METHODS

A combined analysis of two prospective cohorts, including 253 patients who underwent SLNB with/without TAD and with/without ALND following NAC, was performed. Finally, 222 patients (cT1-3N1/ycN0M0) with a clipped lymph node that was radiologically visible were analyzed.

RESULTS

Overall, the clipped node was successfully identified in 246 patients (97.2%) by imaging. Of 222 patients, the clipped lymph nodes were non-SLNs in 44 patients (19.8%). Of patients in cohort B (n=129) with TAD, the clipped node was successfully removed by preoperative image-guided localisation, or the clipped lymph node was removed as the SLN as detected on preoperative SPECT-CT. Among patients with ypSLN(+) (n=109), no significant difference was found in non-SLN positivity at cALND between patients with TAD and RCN (41.7% vs. 46.9%, p=0.581). In the subgroup with TAD with axillary lymph node dissection (ALND; n=60), however, patients with a lymph node (LN) ratio (LNR) less than 50% and one metastatic LN in the TAD specimen were found to have significantly decreased non-SLN positivity compared to others (27.6% vs. 54.8%, p=0.032, and 22.2% vs. 50%, p=0.046).

CONCLUSIONS

TAD by imaging-guided localisation is feasible with excellent identification rates of the clipped node. This approach has also been found to reduce the additional non-SLN positivity rate to encourage omitting ALND in patients with a low metastatic burden undergoing TAD.

摘要

背景

在临床淋巴结阳性（cN+）乳腺癌患者中，与前哨淋巴结活检（SLNB）相比，行腋窝定向清扫术（TAD）是否具有优势存在争议。我们的目的是评估在接受新辅助化疗（NAC）后行 SLNB 联合 TAD 或无 SLNB 联合 TAD 时，能否通过移除夹闭的淋巴结（RCN）来减少 cN+乳腺癌患者完成腋窝淋巴结清扫（cALND）中的残余腋窝疾病。

方法

对 253 例行 SLNB 联合/不联合 TAD 及 NAC 后行 ALND 的前瞻性队列进行联合分析。最终，对 222 例（cT1-3N1/ycN0M0 且夹闭的淋巴结在影像学上可见）存在夹闭淋巴结的患者进行了分析。

结果

在 246 例（97.2%）患者中，通过影像学成功识别了夹闭的淋巴结。在 222 例患者中，44 例（19.8%）患者的夹闭淋巴结为非前哨淋巴结。在队列 B（n=129）中，行 TAD 的患者通过术前影像学引导定位或术前 SPECT-CT 检测到的夹闭淋巴结作为前哨淋巴结成功切除。在前哨淋巴结阳性（ypSLN(+)）的患者（n=109）中，TAD 组与 RCN 组 cALND 中存在非前哨淋巴结阳性的患者比例无显著差异（41.7% vs. 46.9%，p=0.581）。然而，在 TAD 联合腋窝淋巴结清扫（ALND）的亚组（n=60）中，与其他患者相比，前哨淋巴结阳性且 TAD 标本中前哨淋巴结转移数小于 50%或仅存在 1 枚转移性淋巴结的患者，非前哨淋巴结阳性的比例显著降低（27.6% vs. 54.8%，p=0.032；22.2% vs. 50%，p=0.046）。