Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2024 Oct;31(11):7431-7440. doi: 10.1245/s10434-024-15796-7. Epub 2024 Aug 9.
Axillary lymph node dissection is the current standard for management of the axilla in inflammatory breast cancer (IBC). The present study aims to determine whether the initially positive node identified by clip placement accurately represents the overall nodal status of axilla after neoadjuvant chemotherapy (NAC) in IBC.
A retrospective study was conducted on patients with IBC who underwent operation (2014-2023). For patients with IBC who had clip placement in a positive axillary node at diagnosis, operative notes, specimen radiographs, and pathology reports were reviewed to confirm final pathologic status of clipped nodes.
In total, 92 patients with IBC (90 cN+) were identified (median age 54 years, 78% invasive ductal, 10% invasive lobular, and 12% mixed); 81 (90%) were biopsy-proven cN+, with a clip placed in the positive node for 62/81 (77%). All patients were treated with NAC and axillary surgery with median 19 (range 4-49) nodes removed. Among 28 (out of 56) patients with retrieved clipped nodes that were pathologically negative (ypN0), only 1 had an additional positive node with micrometastasis for a false negative rate of 4% (95% CI 1-19%). Conversely, 3/3 patients with isolated tumor cells (ITCs) only in the clipped node had additional axillary disease (ITCs in 1, macrometastasis in 2), and 20/23 (87%) of patients with pathologically positive clipped node (micrometastasis or greater) had additional positive nodes [19/20 (95%) with macrometastasis].
The clipped biopsy-positive axillary node in IBC accurately represented the post-NAC overall axillary nodal status. ITCs post-NAC should be considered positive as an indicator of additional nodes with metastasis.
腋窝淋巴结清扫术是炎性乳腺癌（IBC）腋窝处理的当前标准。本研究旨在确定在 IBC 患者接受新辅助化疗（NAC）后，最初通过夹闭放置在阳性腋窝淋巴结中确定的阳性淋巴结是否准确代表整个腋窝淋巴结状态。
对 2014 年至 2023 年间接受手术的 IBC 患者进行回顾性研究。对于在诊断时夹闭阳性腋窝淋巴结的 IBC 患者，查阅手术记录、标本 X 光片和病理报告以确认夹闭淋巴结的最终病理状态。
共确定了 92 例 IBC 患者（90 例 cN+）（中位年龄 54 岁，78%为浸润性导管癌，10%为浸润性小叶癌，12%为混合性）；81 例（90%）经活检证实为 cN+，其中 62/81 例（77%）的阳性淋巴结夹闭。所有患者均接受 NAC 和腋窝手术治疗，平均切除 19 个（范围 4-49 个）淋巴结。在 28 例（56 例）可获得的夹闭阴性（ypN0）的淋巴结中，仅 1 例有额外的阳性微转移淋巴结，假阴性率为 4%（95%CI 1-19%）。相反，3 例仅在夹闭淋巴结中发现孤立肿瘤细胞（ITC）的患者有额外的腋窝疾病（1 例为 ITC，2 例为宏转移），23 例（87%）夹闭淋巴结阳性（微转移或更大）的患者有额外的阳性淋巴结[19 例（95%）为宏转移]。
在 IBC 中，夹闭的活检阳性腋窝淋巴结准确地代表了 NAC 后整个腋窝淋巴结状态。NAC 后 ITC 应被视为阳性，作为有转移的额外淋巴结的指标。
