Albertini J J, Lyman G H, Cox C, Yeatman T, Balducci L, Ku N, Shivers S, Berman C, Wells K, Rapaport D, Shons A, Horton J, Greenberg H, Nicosia S, Clark R, Cantor A, Reintgen D S
Comprehensive Breast Cancer Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33612-9497, USA.
JAMA. 1996 Dec 11;276(22):1818-22.
To identify the sentinel lymph node(s) (SLN[s]) (the first node[s] draining the primary tumor in the regional lymphatic basin) in patients with invasive breast cancer and to test the hypothesis that the histologic characteristics of the SLN predict the histologic characteristics of the remaining lymph nodes in the axilla.
A prospective trial.
Sixty-two patients with newly diagnosed invasive breast cancers.
Patients underwent intraoperative lymphatic mapping using a combination of a vital blue dye and filtered technetium-labeled sulfur colloid. The SLN was identified and removed, followed by a definitive cancer operation, including a complete axillary node dissection.
The metastatic distribution in the axilla was determined in patients with occult nodal disease.
The SLN was successfully identified in 57 (92%) of 62 patients using the 2 lymphatic mapping procedures. After localization, 18 patients (32%) were found to have metastatic disease, and the SLN tested positive in all 18 patients. There were no "skip" metastases, defined as an SLN that tested negative with higher nodes that tested positive. In 12 (67%) of 18 patients with metastatic disease, the SLN was the only site of disease. The metastatic distribution significantly favored SLN involvement. Among subjects with discordant nodal involvement, the probability of observing the distribution of SLN involvement by chance is very small (P<.001).
This study confirms that lymphatic mapping is technically possible in the patient with breast cancer and that the histologic characteristics of the SLN probably reflect the histologic characteristics of the rest of the axillary lymph nodes. The procedure also allows the pathologist to focus the histologic examination on 1 or 2 nodes, potentially increasing the yield of positive dissections and the accuracy of staging.
确定浸润性乳腺癌患者的前哨淋巴结（区域淋巴引流区中引流原发肿瘤的第一站淋巴结），并检验前哨淋巴结的组织学特征可预测腋窝其余淋巴结组织学特征这一假说。
一项前瞻性试验。
62例新诊断的浸润性乳腺癌患者。
患者术中联合使用活性蓝色染料和过滤后的锝标记硫胶体进行淋巴绘图。确定并切除前哨淋巴结，随后进行确定性癌症手术，包括完整的腋窝淋巴结清扫。
确定隐匿性淋巴结疾病患者腋窝的转移分布情况。
采用两种淋巴绘图方法，62例患者中有57例（92%）成功识别出前哨淋巴结。定位后，18例患者（32%）被发现有转移疾病，且所有18例患者的前哨淋巴结检测均为阳性。不存在“跳跃”转移，即前哨淋巴结检测为阴性而更高位淋巴结检测为阳性的情况。18例有转移疾病的患者中，12例（67%）前哨淋巴结是唯一的病变部位。转移分布明显倾向于前哨淋巴结受累。在淋巴结受累情况不一致的受试者中，偶然观察到前哨淋巴结受累分布的概率非常小（P<0.001）。
本研究证实乳腺癌患者进行淋巴绘图在技术上是可行的，且前哨淋巴结的组织学特征可能反映腋窝其余淋巴结的组织学特征。该方法还可使病理学家将组织学检查集中于1或2个淋巴结，可能提高阳性清扫的检出率和分期的准确性。
