Laws Alison, Leonard Saskia, Vincuilla Julie, Parker Tonia, Kantor Olga, Mittendorf Elizabeth A, Weiss Anna, King Tari A
Division of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA.
Ann Surg Oncol. 2025 Mar;32(3):2023-2028. doi: 10.1245/s10434-024-16625-7. Epub 2024 Dec 4.
Two surgical approaches have emerged for axillary staging in cN1 breast cancer patients after neoadjuvant chemotherapy (NAC): sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). Direct comparisons of technical and oncological outcomes with SLNB versus TAD are lacking.
We routinely performed SLNB from 2017 to 2018 for cN1 breast cancer patients who converted to cN0 after NAC, then adopted TAD from 2019 to 2022. To minimize the false-negative rate (FNR), we required retrieval of ≥3 sentinel lymph nodes (SLN) (2017-2018) or retrieval of the clipped node (CN) and ≥2 SLN (2019-2022). In ypN0 cases meeting these criteria, axillary lymph node dissection (ALND) was omitted. We compared the rate of per-protocol required ALND due to technical failure of SLNB versus TAD and reported axillary recurrence rates.
Among 191 cN1 ypN0 patients, 77 underwent SLNB and 114 underwent TAD. The overall rate of required ALND due to technical failure was 14.7% and did not differ between SLNB versus TAD (16.9% vs. 13.2%, p = 0.38). The most common technical failure with SLNB was retrieving <3 SLN (10.4%); for TAD, it was not retrieving the CN (7.1%). Median follow-up was 3.9 years for SLNB patients and 1.7 years for TAD patients; there were 1 (1.3%) and 0 (0.0%) axillary recurrences, respectively.
Sentinel lymph node biopsy and TAD for cN1 patients after NAC showed equivalent technical failure rates and low axillary recurrence rates. When applying strict criteria to minimize FNR of axillary staging surgery, approximately 15% of ypN0 patients may be overtreated with ALND.
对于接受新辅助化疗（NAC）后cN1期乳腺癌患者的腋窝分期，出现了两种手术方法：前哨淋巴结活检（SLNB）和靶向腋窝清扫术（TAD）。缺乏对SLNB与TAD的技术和肿瘤学结果的直接比较。
2017年至2018年，我们对NAC后转为cN0的cN1期乳腺癌患者常规进行SLNB，然后在2019年至2022年采用TAD。为了将假阴性率（FNR）降至最低，我们要求获取≥3枚前哨淋巴结（SLN）（2017 - 2018年）或获取夹闭淋巴结（CN）及≥2枚SLN（2019 - 2022年）。在符合这些标准的ypN0病例中，省略腋窝淋巴结清扫术（ALND）。我们比较了因SLNB与TAD技术失败而按方案要求进行ALND的比率，并报告腋窝复发率。
在191例cN1 ypN0患者中，77例行SLNB，114例行TAD。因技术失败而需要进行ALND的总体比率为14.7%，SLNB与TAD之间无差异（16.9%对13.2%，p = 0.38）。SLNB最常见的技术失败是获取的SLN＜3枚（10.4%）；对于TAD，是未获取CN（7.1%）。SLNB患者的中位随访时间为3.9年，TAD患者为1.7年；腋窝复发分别为1例（1.3%）和0例（0.0%）。
NAC后cN1患者的前哨淋巴结活检和TAD显示出相当的技术失败率和较低的腋窝复发率。当应用严格标准以将腋窝分期手术的FNR降至最低时，约15%的ypN0患者可能会接受过度的ALND治疗。
