Sandhya Anu, Fahim Muhammad, Kulanathan Aron, Tansie Awa
Breast Surgery, Surrey and Sussex Healthcare Trust, Redhill, GBR.
General Surgery, Surrey and Sussex Healthcare Trust, Redhill, GBR.
Cureus. 2024 Nov 22;16(11):e74250. doi: 10.7759/cureus.74250. eCollection 2024 Nov.
Introduction Current guidelines advocate for a sentinel lymph node biopsy (SLNB) in patients with invasive breast cancer with negative axillary ultrasonography. However, emerging evidence has contradicted this, and SLNB omission has been found to be non-inferior in selected low-risk breast cancers. This retrospective study aimed to evaluate the incidence of SLNB in screen-detected invasive breast cancer. The secondary outcome was to identify risk factors in patients with positive SLNB and further axillary disease. Methods All screen-detected histologically confirmed invasive breast cancer and no evidence of spread to ipsilateral axillary lymph nodes (LNs) on ultrasound scans referred from screening between January 2018 and December 2019 were included in the study. All patients underwent surgical excision of the tumor as either breast conservation surgery or mastectomy, along with sentinel node biopsy. SLNB was performed using the dual technique of radioactive dye and blue dye. Results One hundred forty-nine patients were included in the study, all of whom were females. The mean patient age was 61.9 years old, with the majority 65 (43.6%) of the patients being in their 60s. Breast-conserving surgery (BCS) was performed in 138 (92.6%) patients. Eighty (53.7%) patients presented with right breast cancer. The mean size of invasive cancer was 15 mm. The mean total tumor size, including invasive and in situ, was 20.9 mm. One hundred twenty-seven (85.2%) patients had unifocal presentations, 69 (46.3%) of tumor foci were in the upper outer quadrant (UOQ), 122 (81.9%) of all tumors were ductal carcinoma, 81 (54.4%) patients had histologically grade 2 carcinomas, 135 (90.6%) of all patient tumors were ER-positive, HER2-negative, and six (4%) were ER-positive, HER2-positive. Twelve (8.05%) out of 149 included patients had positive sentinel LN biopsy. Of those 12 patients, eight (66.7%) had one to two nodes sampled, three (25%) had three to four nodes, and one (8.3%) had five or more nodes sampled. Out of 12 positive SNB patients, 11 had completed axillary node clearance (ANC) as per the National Institute for Health and Care Excellence (NICE) guidelines: nine (81.8%) had no further disease, and two (18.2%) had four positive nodes. The mean number of nodes taken in ANC was 15.8 ± 11.5. Of the two patients with positive axillary disease, one had BCS, and the other had a mastectomy. Both were grade 3 IDC, and the mean size was 57.5 mm. Nine patients died within four years of diagnosis, with four due to distant breast metastasis. Conclusion Only 8% of patients had positive SLNB in screen-detected breast cancer, which may support the previous studies of omitting SLNB being non-inferior but only in selected postmenopausal small early breast cancers with normal axillary ultrasound in the absence of any other risk factors. However, close follow-up will be required for disease-free survival, overall survival, and locoregional recurrence in this cohort.
引言 当前指南提倡对腋窝超声检查阴性的浸润性乳腺癌患者进行前哨淋巴结活检（SLNB）。然而，新出现的证据对此提出了反驳，并且发现在特定低风险乳腺癌中省略SLNB并无劣势。这项回顾性研究旨在评估筛查发现的浸润性乳腺癌中SLNB的发生率。次要结果是确定前哨淋巴结活检阳性且存在进一步腋窝疾病的患者的危险因素。方法 纳入2018年1月至2019年12月期间筛查转诊的所有经组织学确诊的浸润性乳腺癌且超声检查无同侧腋窝淋巴结转移证据的患者。所有患者均接受了肿瘤手术切除，术式为保乳手术或乳房切除术，同时进行前哨淋巴结活检。前哨淋巴结活检采用放射性染料和蓝色染料双重技术。结果 149例患者纳入研究，均为女性。患者平均年龄61.9岁，其中大多数（43.6%，即65例）为60多岁。138例（92.6%）患者接受了保乳手术（BCS）。80例（53.7%）患者为右乳癌。浸润性癌平均大小为15mm。包括浸润性和原位癌在内的肿瘤平均总大小为20.9mm。127例（85.2%）患者为单发病灶，69个（46.3%）肿瘤病灶位于外上象限（UOQ），所有肿瘤中有122例（81.9%）为导管癌，81例（54.4%）患者为组织学2级癌，所有患者肿瘤中有135例（90.6%）雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性，6例（4%）为ER阳性、HER2阳性。149例纳入患者中有12例（8.05%）前哨淋巴结活检阳性。在这12例患者中，8例（66.7%）取样1至2个淋巴结，3例（25%）取样3至4个淋巴结，1例（8.3%）取样5个或更多淋巴结。在12例前哨淋巴结活检阳性患者中，11例按照英国国家卫生与临床优化研究所（NICE）指南完成了腋窝淋巴结清扫（ANC）：9例（81.8%）无进一步疾病，2例（18.2%）有4个阳性淋巴结。腋窝淋巴结清扫术中平均取淋巴结数为15.8±11.5个。在2例腋窝疾病阳性患者中，1例接受了保乳手术，另1例接受了乳房切除术。二者均为3级浸润性导管癌（IDC），平均大小为57.5mm。9例患者在诊断后4年内死亡，其中4例死于远处乳腺转移。结论 在筛查发现的乳腺癌中，仅8%的患者前哨淋巴结活检阳性，这可能支持既往关于省略前哨淋巴结活检并无劣势的研究，但仅适用于绝经后、腋窝超声正常且无任何其他危险因素的特定早期小乳腺癌。然而，对于该队列患者的无病生存期、总生存期和局部区域复发，仍需要密切随访。
