van Tienhoven G, Borger J H, Passchier D H, Hart A A, Rutgers E J, van Dongen J A, Bartelink H
Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur J Cancer. 1995 Nov;31A(12):1965-8. doi: 10.1016/0959-8049(95)00484-x.
To evaluate the prognostic significance of the axillary apex biopsy and its impact on clinical practice, a retrospective analysis was performed in 875 patients with clinically operable breast cancer who underwent this procedure from 1977 to 1985 (165 TNM stage I; 512 TNM stage II; 198 TNM stage IIIA). Apex biopsy is performed as a staging procedure. Apex biopsy positive patients are treated by radiotherapy alone, while apex biopsy negative patients are treated with breast conserving therapy or mastectomy, both including complete axillary dissection. The apex biopsy was tumour positive in 4% of TNM stage I patients; 17% of stage II patients and 40% of stage IIIA patients. Among patients with clinically node-negative disease, the apex biopsy was positive in 12%; in patients with palpable suspected lymph nodes this figure was 45%. Actuarial 8 y survival rates for patients with stage I, II and III disease and a negative apex biopsy were 83, 70 and 50%, respectively. The corresponding figures for patients with a positive apex biopsy were 60, 28 and 14%. In a multivariate analysis, a positive apex biopsy, clinical N classification and T classification were independent prognostic factors for survival (P < 0.0001). We conclude that a positive apex biopsy is rare in clinical stage I breast cancer, and that in patients with TNM stage II and III disease the procedure is an important tool to assess prognosis pre-operatively.
为评估腋窝尖部活检的预后意义及其对临床实践的影响，我们对1977年至1985年间接受该操作的875例临床可手术乳腺癌患者进行了回顾性分析（165例TNM I期；512例TNM II期；198例TNM IIIA期）。腋窝尖部活检作为一种分期操作进行。腋窝尖部活检阳性的患者仅接受放疗，而活检阴性的患者则接受保乳治疗或乳房切除术，两者均包括完整的腋窝淋巴结清扫。腋窝尖部活检在4%的TNM I期患者、17%的II期患者和40%的IIIA期患者中呈肿瘤阳性。在临床淋巴结阴性的患者中，腋窝尖部活检阳性率为12%；在可触及疑似淋巴结的患者中，这一数字为45%。腋窝尖部活检阴性的I期、II期和III期患者的8年精算生存率分别为83%、70%和50%。腋窝尖部活检阳性的患者相应数字分别为60%、28%和14%。在多变量分析中，腋窝尖部活检阳性、临床N分期和T分期是生存的独立预后因素（P < 0.0001）。我们得出结论，腋窝尖部活检阳性在临床I期乳腺癌中很少见，在TNM II期和III期疾病患者中，该操作是术前评估预后的重要工具。
