Pellicciaro Marco, Materazzo Marco, Bertolo Alice, Tacconi Federico, Bastone Sebastiano Angelo, Calicchia Francesco, Eskiu Denisa, Toscano Enrica, Sadri Amir, Treglia Michele, Berretta Massimiliano, Longo Benedetto, Cervelli Valerio, Buonomo Oreste Claudio, Vanni Gianluca
Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy.
PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy.
Cancers (Basel). 2025 Feb 26;17(5):798. doi: 10.3390/cancers17050798.
Despite advancements in breast cancer surgery, the decision-making process for axillary treatment remains complex, necessitating new predictors like the tumor size to Ki67 proliferation index ratio. Intraoperative examination of the sentinel lymph node is performed to reduce the risk of a secondary surgery. Several studies have demonstrated that even in the presence of moderate nodal involvement, local disease control can be achieved by omitting axillary lymph node dissection (ALND). The aim of our retrospective study is to compare patients subjected to sentinel lymph node biopsy (SNLB) with or without intraoperative evaluation. This study included patients with breast cancer who underwent breast-conserving surgery and SNLB. Of the 551 patients, 333 (60.4%) underwent an SNLB intraoperative evaluation (SLNB-IE), while 218 (39.6%) underwent sentinel lymph node dissection diagnostic evaluation (SLNB-DE). Our analysis revealed that the tumor size to Ki67 ratio is an independent predictive factor for axillary tumor burden, suggesting its utility in surgical decision-making. A secondary ALND was performed in 2 (0.6%) vs. 7 (2.8%), = 0.032, and in 1 (0.4%) vs. 4 (2.1%), = 0.171, excluding patients with T ≥ 2. Surgical time was significantly shorter ( > 0.001) in the SLNB-DE group. According to a multivariate analysis, lesion dimension (OR 1.678; 95%CI 1.019-2.145; WALD:7.588; = 0.006) and the ratio of lesion dimension to the Ki67 proliferation index (OR 0.08; 95%CI 0.011-0.141; WALD:11.004 = 0.001) were both predictive factors for a higher axillary tumor burden. A value of 0.425, which is the ratio of tumor dimension to the Ki67 proliferation index, was identified as a predictor of tumor burden in the axilla (sensitivity, 78%; specificity, 87.5%). Intraoperative evaluation of SNLB may be omitted but could be considered in potential candidates for cyclin inhibitor and cN0 therapy with a higher ratio of tumor dimension to the Ki67 proliferation index in order to avoid secondary surgery.
尽管乳腺癌手术取得了进展，但腋窝治疗的决策过程仍然复杂，需要像肿瘤大小与Ki67增殖指数之比这样的新预测指标。进行前哨淋巴结的术中检查以降低二次手术的风险。多项研究表明，即使存在中度淋巴结受累，通过省略腋窝淋巴结清扫术（ALND）也可实现局部疾病控制。我们这项回顾性研究的目的是比较接受或未接受术中评估的前哨淋巴结活检（SNLB）患者。本研究纳入了接受保乳手术和SNLB的乳腺癌患者。在551例患者中，333例（60.4%）接受了SNLB术中评估（SLNB-IE），而218例（39.6%）接受了前哨淋巴结清扫诊断评估（SLNB-DE）。我们的分析显示，肿瘤大小与Ki67之比是腋窝肿瘤负荷的独立预测因素，表明其在手术决策中的效用。排除T≥2的患者后，二次ALND的实施率在SLNB-IE组为2例（0.6%），在SLNB-DE组为7例（2.8%），P = 0.032；在SLNB-IE组为1例（0.4%），在SLNB-DE组为4例（2.1%），P = 0.171。SLNB-DE组的手术时间显著更短（P>0.001）。根据多变量分析，病灶大小（OR 1.678；95%CI 1.019 - 2.145；WALD：7.588；P = 0.006）以及病灶大小与Ki67增殖指数之比（OR 0.08；95%CI 0.011 - 0.141；WALD：11.004，P = 0.001）均是腋窝肿瘤负荷较高的预测因素。肿瘤大小与Ki67增殖指数之比为0.425被确定为腋窝肿瘤负荷的预测指标（敏感性为78%，特异性为87.5%）。SNLB的术中评估可以省略，但对于细胞周期蛋白抑制剂和cN0治疗的潜在候选患者，若肿瘤大小与Ki67增殖指数之比更高，则可考虑进行术中评估，以避免二次手术。
