社区管理式医疗环境下乳腺癌的前哨淋巴结切除术

Sentinel lymphadenectomy for breast cancer in a community managed care setting.

作者信息

Guenther J M, Krishnamoorthy M, Tan L R

机构信息

Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.

出版信息

Cancer J Sci Am. 1997 Nov-Dec;3(6):336-40.

PMID:9403045

Abstract

PURPOSE

To evaluate the feasibility, accuracy, and reproducibility of intraoperative lymphatic mapping and sentinel lymphadenectomy (IOLM/SL) in the staging of breast cancer patients in a community managed care setting.

PATIENTS AND METHODS

One hundred forty-five patients with primary breast cancer were prospectively studied over a 26-month period. They underwent vital dye injection at their primary breast cancer site. Lymphatic channels were traced to the sentinel lymph node, which was excised, serially sectioned, and examined. A level I and II axillary lymph node dissection and definitive breast surgery were then performed.

RESULTS

Sentinel nodes were identified in 103 of 145 procedures (71.0%). Sentinel and nonsentinel lymph nodes were concordant in 100 of 103 cases (97.1%). Three patients (9.7%) had falsely negative sentinel nodes; there were none in the last 80 patients. Of 28 positive sentinel nodes, 12 (42.9%) represented the only tumor-containing node within the axilla. Sentinel nodes were significantly more likely to contain tumor than nonsentinel nodes (33/50, 66.0% vs 54/467, 11.6%, P < 0.0001). IOLM/SL identified more micrometastases (< 2 mm) than standard axillary lymph node dissection (13/33, 39.6% vs 4/177, 2.2%, P < 0.001). Nine of 42 patients (21.4%) whose sentinel node could not be identified had five or more nodal metastases. Two of six patients with presumed Tis primaries had nodal metastases.

DISCUSSION

IOLM/SL accurately identifies the sentinel lymph node(s) most likely to contain metastatic disease. A procedural learning curve was present. An unsuccessful IOLM/SL was a risk factor for considerable nodal metastases. IOLM/SL with a tumor-free sentinel node may obviate a formal axillary lymph node dissection. The technique was feasible, economical, and reproducible within the context of a community managed care facility, while not placing exacting demands on operating room, pathology, or nuclear medicine personnel.

摘要

目的

评估在社区管理式医疗环境中，术中淋巴管造影和前哨淋巴结切除术（IOLM/SL）用于乳腺癌患者分期的可行性、准确性和可重复性。

患者与方法

在26个月的时间里，对145例原发性乳腺癌患者进行了前瞻性研究。他们在原发性乳腺癌部位接受了活性染料注射。追踪淋巴管至前哨淋巴结，将其切除、连续切片并检查。然后进行I级和II级腋窝淋巴结清扫及确定性乳房手术。

结果

145例手术中有103例（71.0%）识别出了前哨淋巴结。103例中的100例（97.1%）前哨淋巴结与非前哨淋巴结情况一致。3例患者（9.7%）前哨淋巴结出现假阴性；最近80例患者中无此情况。在28个阳性前哨淋巴结中，12个（42.9%）是腋窝内唯一含有肿瘤的淋巴结。前哨淋巴结比非前哨淋巴结更有可能含有肿瘤（33/50，66.0%对54/467，11.6%，P<0.0001）。IOLM/SL比标准腋窝淋巴结清扫发现更多微转移（<2mm）（13/33，39.6%对4/177，2.2%，P<0.001）。42例未识别出前哨淋巴结的患者中有9例（21.4%）有五个或更多淋巴结转移。6例假定为Tis期原发性肿瘤的患者中有2例有淋巴结转移。