Dowlatshahi K, Snider H C, Kim R
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Ann Surg Oncol. 1995 Sep;2(5):424-8. doi: 10.1007/BF02306375.
The metastatic status of the axillary nodes is prognostically important but its value has been questioned in the management of nonpalpable breast tumors. This study correlates the incidence of positive nodes with the size of the primary nonpalpable tumors.
We retrospectively analyzed 220 invasive and 21 microinvasive breast cancers that were excised after needle localization and for which axillary dissections were subsequently performed. Of invasive cancers, 166 presented as mass lesions with or without microcalcifications and 54 as microcalcifications alone. The size of the mass lesions (n = 166) was determined mammographically and on pathologic specimens. They were subdivided into five groups according to diameter: (a) < or = 5 mm, (b) 6-10 mm, (c) 11-20 mm, (d) > 20 mm, and (e) unrecorded size.
Axillary metastases were found in 9% of patients whose cancer presented as microcalcifications alone. They were found in 0, 11, and 22% of patients in mammographic groups, a, b, and c, respectively. In the corresponding groups in which size was determined from the pathology report, metastases were found in 5, 10, and 27%.
The size of nonpalpable breast cancers measured on the excised gross specimen and by mammogram accurately predicts the likelihood of axillary node metastasis.
腋窝淋巴结的转移状态对预后具有重要意义，但其在不可触及乳腺肿瘤的治疗中的价值受到质疑。本研究将阳性淋巴结的发生率与不可触及的原发性肿瘤的大小进行关联分析。
我们回顾性分析了220例浸润性乳腺癌和21例微浸润性乳腺癌，这些病例均在针定位后切除，随后进行了腋窝清扫。在浸润性癌中，166例表现为有或无微钙化的肿块，54例仅表现为微钙化。对肿块（n = 166）的大小进行了乳腺X线摄影测量和病理标本测量。根据直径将其分为五组：（a）≤5mm，（b）6 - 10mm，（c）11 - 20mm，（d）>20mm，（e）未记录大小。
仅表现为微钙化的癌症患者中，9%发现腋窝转移。在乳腺X线摄影分组a、b和c的患者中，腋窝转移率分别为0%、11%和22%。在根据病理报告确定大小的相应分组中，转移率分别为5%、10%和27%。
在切除的大体标本上以及通过乳腺X线摄影测量的不可触及乳腺癌的大小，能够准确预测腋窝淋巴结转移的可能性。
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