Singhal H, O'Malley F P, Tweedie E, Stitt L, Tonkin K S
London Regional Cancer Centre, Department of Pathology, Victoria Hospital, Ont.
Can J Surg. 1997 Oct;40(5):377-82.
To determine the role of axillary node dissection by studying patient and tumour characteristics of invasive breast cancer through the Ontario Breast Screening Program (OBSP).
A retrospective evaluation.
The London, Ont., branch of the OBSP.
Three groups of women seen were studied: 50 women with screen-detected breast cancers, which were palpable and detected by the nurse-examiner, 62 women with occult screen-detected breast cancers and 353 age matched women with invasive breast cancer from the LRCC prospective database, who served as controls.
The proportion of involved axillary nodes within the 3 groups based on patient and tumour characteristics.
Twenty-five (22.3%) of the 112 women had screen-detected tumours less than 1 cm in dimension, but only 1 had an involved axillary node. Twelve (19%) of the 62 women with occult screen-detected tumours had involved lymph nodes compared with 17 (34%) of the 50 women with palpable screen-detected cancers (NS). In the control group tumour dimension less than 1 cm versus 1 cm or larger had a marked effect on the probability of axillary node involvement (12.5% v. 40.7%, p = 0.001). In the palpable screen-detected group 3 times as many women with outer quadrant or central lesions had involved nodes as those with inner quadrant lesions (38% v. 12%) and for those with a family history of breast cancer almost twice as many had involved axillary nodes. In occult screen-detected patients there was more nodal involvement in patients aged 60 years or less than in those older than 60 years (35% v. 10%, p = 0.042); only 4 of 41 patients older than 60 years had involved nodes at surgery. A significant difference in nodal involvement was found with respect to high or intermediate grade versus low grade lesions in the occult group (44% v. 12%, p = 0.033). In the control group, tumour grade (intermediate and high [45.3%] v. low [20.0%]) and hormone replacement therapy (HRT) (current or recent use [56.5%] v. no use [34.5%]) were significant findings (p < 0.001 and p = 0.005 respectively).
Women older than 60 years with tumours smaller than 1 cm had a low probability of nodal positivity (0% to 8.7%), but there is insufficient information in this group to give a 95% or better prediction of nodal status at the time of surgery. Studies of minimally invasive techniques such as sentinel node biopsy are needed in this group to minimize surgical morbidity in these women who, as a result of early diagnosis, have an excellent long-term outlook.
通过安大略省乳腺癌筛查项目（OBSP）研究浸润性乳腺癌患者及肿瘤特征，以确定腋窝淋巴结清扫的作用。
回顾性评估。
OBSP安大略省伦敦分部。
研究了三组女性：50名通过筛查发现的可触及乳腺癌女性，由护士检查发现；62名隐匿性筛查发现的乳腺癌女性；以及来自LRCC前瞻性数据库的353名年龄匹配的浸润性乳腺癌女性作为对照。
根据患者和肿瘤特征，三组中腋窝淋巴结受累的比例。
112名女性中有25名（22.3%）通过筛查发现肿瘤直径小于1厘米，但只有1名有腋窝淋巴结受累。62名隐匿性筛查发现肿瘤的女性中有12名（19%）有淋巴结受累，而50名可触及筛查发现癌症的女性中有17名（34%）有淋巴结受累（无显著性差异）。在对照组中，肿瘤直径小于1厘米与1厘米或更大对腋窝淋巴结受累的概率有显著影响（12.5%对40.7%，p = 0.001）。在可触及筛查发现组中，外象限或中央病变的女性有淋巴结受累的人数是内象限病变女性的3倍（38%对12%），有乳腺癌家族史的女性有腋窝淋巴结受累的人数几乎是前者的两倍。在隐匿性筛查发现的患者中，60岁及以下患者的淋巴结受累情况比60岁以上患者更多（35%对10%，p = 0.042）；60岁以上的41名患者中只有4名在手术时有淋巴结受累。在隐匿性组中，高或中级别病变与低级别病变的淋巴结受累情况存在显著差异（44%对12%，p = 0.033）。在对照组中，肿瘤分级（中高级别[45.3%]对低级别[20.0%]）和激素替代疗法（HRT）（当前或近期使用[56.5%]对未使用[34.5%]）是显著结果（分别为p < 0.001和p = 0.005）。
60岁以上且肿瘤小于1厘米的女性淋巴结阳性概率较低（0%至8.7%），但该组信息不足以在手术时对淋巴结状态进行95%或更高准确率的预测。需要对该组进行前哨淋巴结活检等微创技术的研究，以尽量减少这些因早期诊断而长期预后良好的女性的手术并发症。
