Cordeiro Mariana Robalo, Gante Inês, David Daniela, Gomes Ana, Figueiredo-Dias Margarida
Gynecology Department, Coimbra University Hospital Center, Coimbra, Portugal.
University Clinic of Gynecology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Breast J. 2024 Nov 8;2024:4864443. doi: 10.1155/2024/4864443. eCollection 2024.
Establishing an accurate prognosis for women diagnosed with breast cancer (BC) is extremely challenging. Axillary lymph node (ALN) evaluation is considered of major prognostic value. The one-step nucleic acid amplification (OSNA) assay is currently used for assessing axillary sentinel lymph node (SLN) status in BC. Additionally, total tumor load (TTL) may help predict further metastatic axillary involvement beyond the SLN. The prognostic value of primary BC location remains controversial due to lack of consensus on the biological differences among tumors at various sites. Evidence suggests that tumors in the internal quadrants (INLs) have worse prognosis compared to those in the external quadrants. Furthermore, ALN involvement is believed to be mainly associated with external quadrant tumors, mainly due to the lymphatic drainage system of the breast. This pilot observational study, despite lacking a control group and having a relatively small sample size, is the first to evaluate the potential relationship between primary BC location and ALN metastasis using the OSNA assay. A sample of consecutive BC patients undergoing axillary staging with the OSNA assay were included. Tumors were categorized into three groups based on primary location: external quadrants and axillary tail (EXL), INLs, and nipple and areola location (NAL). Although not statistically significant, the INL group exhibited a higher mean TTL. Additionally, no significant differences were observed between groups concerning SLN detection techniques, SLN status, number of metastatic SLN, or mean TTL. These findings support the use of the innovative tracer superparamagnetic iron oxide regardless of tumor site. This study underscores the importance of understanding the relationship between BC location and ALN status, which may improve prognostic stratification and targeted therapies based on tumor site. If these observations are confirmed in larger, multicentric studies, the potential conclusions may shift the paradigm of INL tumor treatment, significantly impacting clinical practice and research.
对被诊断为乳腺癌（BC）的女性建立准确的预后评估极具挑战性。腋窝淋巴结（ALN）评估被认为具有重要的预后价值。一步核酸扩增（OSNA）检测目前用于评估BC患者腋窝前哨淋巴结（SLN）状态。此外，总肿瘤负荷（TTL）可能有助于预测SLN以外的腋窝进一步转移受累情况。由于对不同部位肿瘤的生物学差异缺乏共识，原发性BC位置的预后价值仍存在争议。有证据表明，内象限（INL）的肿瘤比外象限的肿瘤预后更差。此外，ALN受累被认为主要与外象限肿瘤相关，主要是由于乳腺的淋巴引流系统。这项初步观察性研究尽管缺乏对照组且样本量相对较小，但却是首次使用OSNA检测评估原发性BC位置与ALN转移之间的潜在关系。纳入了一组连续接受OSNA检测腋窝分期的BC患者。根据原发部位将肿瘤分为三组：外象限和腋窝尾部（EXL）、INL以及乳头和乳晕部位（NAL）。尽管无统计学意义，但INL组的平均TTL较高。此外，在SLN检测技术、SLN状态、转移SLN数量或平均TTL方面，各组之间未观察到显著差异。这些发现支持无论肿瘤部位如何都使用创新示踪剂超顺磁性氧化铁。本研究强调了理解BC位置与ALN状态之间关系的重要性，这可能会改善基于肿瘤部位的预后分层和靶向治疗。如果这些观察结果在更大规模的多中心研究中得到证实，潜在的结论可能会改变INL肿瘤治疗的模式，对临床实践和研究产生重大影响。
