Stutz Kathleen, Mason Holly, Niakan Shiva, Coulter Aixa Perez, Casaubon Jesse, Friedrich Ann-Kristin U
Department of Surgery, Loma Linda University Health, Loma Linda, CA, 923754, USA.
Sutter Gould Medical Foundation - Breast Health and Gynecology, Modesto, CA, 95354, USA.
Breast Cancer Res Treat. 2025 Apr;210(3):605-613. doi: 10.1007/s10549-024-07598-y. Epub 2025 Jan 8.
Sentinel lymph node biopsy (SLNB) is a staging procedure used to guide treatment for patients with breast cancer. Multiple variations in the SLNB technique have been described. We questioned how technique impacts the number of sentinel lymph nodes (SLNs) removed and associated complications.
Patients with breast cancer who were treated with lumpectomy and SLNB between 2018 and 2023 were analyzed. Patients were excluded if they had prior ipsilateral breast or axillary surgery or chest wall radiation, underwent neoadjuvant chemotherapy or endocrine therapy, or subsequently required ALND. Demographics, surgical technique, and operative and pathological data were collected. Complication rates were compared between more (4+) or fewer (1-3) SLNs removed.
A total of 643 patients were included, with an average of 2.44 LNs removed (range 1-11). The overall complication rate was 19.8%, with a 4.4% lymphedema rate. The lymphedema rate was higher among patients who had more nodes removed. An average of 2.5 LNs were removed with dual mapping vs. 2.0 with technetium alone (p = 0.15). Breast massage had no effect on the number of SLNs removed (p = 0.12) but did impact blue dye uptake (p = 0.001).
Surgical technique did not significantly impact the number of nodes removed. Removing more nodes was associated with a greater risk of lymphedema.
前哨淋巴结活检（SLNB）是一种用于指导乳腺癌患者治疗的分期程序。已描述了SLNB技术的多种变体。我们质疑技术如何影响切除的前哨淋巴结（SLN）数量及相关并发症。
分析了2018年至2023年间接受保乳手术和SLNB治疗的乳腺癌患者。如果患者先前有同侧乳房或腋窝手术史、胸壁放疗史、接受过新辅助化疗或内分泌治疗，或随后需要进行腋窝淋巴结清扫（ALND），则将其排除。收集了人口统计学、手术技术以及手术和病理数据。比较了切除较多（4个以上）或较少（1 - 3个）SLN的患者的并发症发生率。
共纳入643例患者，平均切除淋巴结2.44个（范围1 - 11个）。总体并发症发生率为19.8%，淋巴水肿发生率为4.4%。切除淋巴结较多的患者淋巴水肿发生率更高。双重定位平均切除2.5个淋巴结，而单独使用锝平均切除2.0个淋巴结（p = 0.15）。乳房按摩对切除的SLN数量没有影响（p = 0.12），但确实影响蓝色染料摄取（p = 0.001）。
手术技术对切除的淋巴结数量没有显著影响。切除更多淋巴结与淋巴水肿风险增加相关。
