Kiyosawa Nami, Oba Takaaki, Iji Ryoko, Morikawa Hiroki, Amitani Masatsugu, Chino Tatsunori, Shimizu Tadafumi, Ono Mayu, Ito Tokiko, Kanai Toshiharu, Maeno Kazuma, Ito Ken-Ichi
Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Gland Surg. 2024 Nov 30;13(11):2055-2067. doi: 10.21037/gs-24-346. Epub 2024 Nov 26.
Sentinel lymph node biopsy (SNB) using radioisotopes is a standard method for assessing axillary lymph node status in patients with breast cancer. Although preoperative lymphoscintigraphy can estimate the number of sentinel lymph nodes (SNs), multiple radioactive SNs are often identified, even when lymphoscintigraphy reveals only one SN. Importantly, metastases are not always observed in the most radioactive SN (hottest SN). This study aimed to determine the significance of metastases in the second or less radioactive SNs when the hottest SN is negative.
We retrospectively analyzed 114 patients with breast cancer with positive SNs who underwent axillary lymph node dissection. The clinicopathological characteristics, SN radioactivity, and axillary lymph node status were evaluated.
Twenty-six patients exhibited metastasis in the second or less radioactive SNs without metastasis in the hottest SN. These patients had a lower risk of non-SN metastasis compared with those with metastasis to the hottest SN (P=0.03). Multivariate analysis identified metastasis in the hottest SN [hazard ratio (HR) 4.93, P=0.01] and the detection of ≥2 SNs by lymphoscintigraphy (HR 3.36, P=0.01) as independent predictors of non-SN metastasis. None of the patients with only one lymph node detected by lymphoscintigraphy and metastasis to the second or less SNs without metastasis to the hottest SN showed non-SN metastasis.
Patients with metastasis in the second or less radioactive SNs, but not in the hottest SN, have a lower risk of non-SN metastasis than those with a positive hottest SN. Combining radioactivity with lymphoscintigraphic information can enhance the accuracy of non-SN status prediction.
使用放射性同位素的前哨淋巴结活检（SNB）是评估乳腺癌患者腋窝淋巴结状态的标准方法。尽管术前淋巴闪烁显像可以估计前哨淋巴结（SN）的数量，但即使淋巴闪烁显像仅显示一个SN，也常常会发现多个放射性SN。重要的是，转移并不总是出现在放射性最强的SN（最热点SN）中。本研究旨在确定当最热点SN为阴性时，第二或放射性较弱的SN中转移的意义。
我们回顾性分析了114例前哨淋巴结阳性并接受腋窝淋巴结清扫术的乳腺癌患者。评估了临床病理特征、SN放射性和腋窝淋巴结状态。
26例患者在第二或放射性较弱的SN中出现转移，而最热点SN未出现转移。与转移至最热点SN的患者相比，这些患者非前哨淋巴结转移的风险较低（P=0.03）。多因素分析确定最热点SN中的转移[风险比（HR）4.93，P=0.01]和淋巴闪烁显像检测到≥2个SN（HR 3.36，P=0.01）是非前哨淋巴结转移的独立预测因素。淋巴闪烁显像仅检测到一个淋巴结且转移至第二或放射性较弱的SN而未转移至最热点SN的患者均未出现非前哨淋巴结转移。
第二或放射性较弱的SN中出现转移但最热点SN未出现转移的患者，其非前哨淋巴结转移的风险低于最热点SN为阳性的患者。将放射性与淋巴闪烁显像信息相结合可以提高非前哨淋巴结状态预测的准确性。
