Wang Tong, Wang Yilin, Xu Yilin, Cui Qi
Second Department of Breast Tumor, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060, China.
National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 30060, China.
Sci Rep. 2025 Jul 1;15(1):21389. doi: 10.1038/s41598-025-06668-5.
This study aimed to determine the key risk factors affecting sentinel lymph node (SLN) metastasis and to help improve the selection of appropriate candidates for SLN biopsy (SLNB). A total of 2143 cases that underwent SLNB were included. Multivariate analysis included the statistically significant parameters in univariate analysis and revealed the independent risk factors for SLN metastasis: age younger than 40 years old, central tumor location, tumor larger than 3 cm, round-shaped and cortex-thickened axillary lymph node examined by ultrasound, lymphovascular invasion (LVI), and histological classification of invasive breast carcinoma of no special type (IBC-NST) and invasive micropapillary carcinoma (IMPC). The most powerful prognostic factor for SLN metastasis is IMPC (P < 0.001), which increases more than 11 times the risk of SLN positivity. The distance between the tumor and nipple of ≤ 1 cm, LVI, and age younger than 40 years old are also with P value < 0.001. The identification of predictors for SLN metastases based on clinicopathological characteristics could guide the SLNB practice conveniently, especially in less developed areas. Patients with theses revealed adverse features should undergo SLNB with deliberation to avoid a second surgery, particularly when multiple risk factors exist.
本研究旨在确定影响前哨淋巴结（SLN）转移的关键危险因素，并有助于改进前哨淋巴结活检（SLNB）合适候选者的选择。共纳入2143例行SLNB的病例。多因素分析纳入单因素分析中有统计学意义的参数，揭示了SLN转移的独立危险因素：年龄小于40岁、肿瘤位于中央、肿瘤大于3 cm、超声检查腋窝淋巴结呈圆形且皮质增厚、淋巴管侵犯（LVI）以及非特殊类型浸润性乳腺癌（IBC-NST）和浸润性微乳头状癌（IMPC）的组织学分类。SLN转移最有力的预后因素是IMPC（P＜0.001），其使SLN阳性风险增加超过11倍。肿瘤与乳头距离≤1 cm、LVI以及年龄小于40岁的P值也＜0.001。基于临床病理特征识别SLN转移的预测因素可方便地指导SLNB实践，尤其是在欠发达地区。具有这些不良特征的患者应慎重考虑行SLNB以避免二次手术，尤其是存在多个危险因素时。
