腋窝清扫术在乳腺钼靶检测到的癌中的作用。

Pandelidis S M, Peters K L, Walusimbi M S, Casady R L, Laux S V, Cavanaugh S H, Bauer T L

Department of Surgery, Emig Research Center of York Hospital, Pa, USA.

J Am Coll Surg. 1997 Apr;184(4):341-5.

BACKGROUND

Axillary dissection remains a standard component of the treatment of invasive carcinoma of the breast. The presence of metastases to the regional lymph nodes guides adjuvant therapy and aids in determining prognosis. Mammography results in the discovery of small and often node-negative carcinomas of the breast.

STUDY DESIGN

This 15-year, retrospective analysis investigated whether certain patients with small tumors could be spared the morbidity of axillary dissection.

RESULTS

Medical records showed that from January 1980 to May 1995, 4,543 needle localization biopsies were done at York Hospital because of abnormalities detected on mammograms. Of these, 703 (15.5 percent) proved to be carcinoma. Of the carcinomas, 68 percent were infiltrating ductal carcinoma, 26 percent were ductal carcinoma in situ, and 5.4 percent were infiltrating lobular carcinoma. Axillary dissection was done on 588 patients, and 88.1 percent of the patients had no metastases to axillary lymph nodes. No axillary metastases were present in 109 patients with ductal carcinoma in situ who underwent axillary lymph node dissection or in 21 patients with microscopic invasive tumors. Only two of 54 patients with a T1a tumor (tumor [T], < or = 0.5 cm) had positive axillary nodes. Only one of 29 patients with a well-differentiated T1b tumor (T, > 0.5 to < or = 1 cm) had metastatic axillary nodes. In the presence of negative axillary lymph nodes, 19.2 percent of patients with a T1a tumor, 33.7 percent of patients with a T1b tumor, 60 percent of patients with a T1c tumor (T, > 1 to < or = 2 cm), and 78.9 percent of patients with a T2 tumor (T, > 2 cm) were given adjuvant chemotherapy or hormonal therapy.

CONCLUSIONS

Patients with ductal carcinoma in situ and microscopic invasive tumors do not require node dissections. Possibly patients with T1a tumors and patients with well-differentiated, estrogen-receptor positive, progesterone-receptor positive, T1b tumors can also be spared axillary node dissection. By following this approach on occasion, patients with positive nodes might not undergo axillary lymph node dissection, but they may still be offered adjuvant therapy.

背景

腋窝清扫术仍然是乳腺癌浸润性癌治疗的标准组成部分。区域淋巴结转移情况可指导辅助治疗并有助于判断预后。乳腺钼靶检查可发现乳腺的小癌灶，且这些癌灶通常无淋巴结转移。

研究设计

这项为期15年的回顾性分析调查了某些小肿瘤患者是否可以避免腋窝清扫术带来的并发症。

结果

病历显示，1980年1月至1995年5月期间，约克医院因乳腺钼靶检查发现异常而进行了4543例针吸定位活检。其中，703例（15.5%）被证实为癌症。在这些癌症中，68%为浸润性导管癌，26%为导管原位癌，5.4%为浸润性小叶癌。588例患者接受了腋窝清扫术，88.1%的患者腋窝淋巴结无转移。109例接受腋窝淋巴结清扫术的导管原位癌患者和21例微小浸润性肿瘤患者均无腋窝转移。54例T1a期肿瘤（肿瘤直径[T]≤0.5 cm）患者中只有2例腋窝淋巴结阳性。29例高分化T1b期肿瘤（T，>0.5至≤1 cm）患者中只有1例有腋窝转移淋巴结。在腋窝淋巴结阴性的情况下，T1a期肿瘤患者中有19.2%、T1b期肿瘤患者中有33.7%、T1c期肿瘤患者（T，>1至≤2 cm）中有60%以及T2期肿瘤患者（T，>2 cm）中有78.9%接受了辅助化疗或激素治疗。