Kapteijn B A, Nieweg O E, Petersen J L, Rutgers E J, Hart A A, van Dongen J A, Kroon B B
Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam.
Eur J Surg Oncol. 1998 Oct;24(5):427-30. doi: 10.1016/s0748-7983(98)92372-1.
To examine the hypothesis that lymphatic dissemination in breast cancer occurs sequentially.
Thirty patients with clinically localized adenocarcinoma were studied. Patent blue dye was administered into the tumour at the beginning of a modified radical mastectomy or segmental mastectomy with en bloc axillary lymph-node dissection (ALND). In the removed specimen, blue-stained lymphatic channels were dissected from the primary tumour to the first draining lymph node(s) (sentinel node(s)).
Identification of a sentinel node (SN) was successful in 26 patients (87%). In 10 patients the SN was tumour-positive. In six of these patients, the SN was the only tumour-positive node. There was no incidence of 'skip' metastasis.
This study confirms the sequential nature of lymphatic dissemination. When confirmed in vivo, these data may lead to a substantial reduction of the need for ALND without compromising survival and regional control and without loss of prognostic and staging information.
检验乳腺癌淋巴扩散是循序渐进发生的这一假说。
对30例临床局限性腺癌患者进行研究。在改良根治性乳房切除术或保乳根治术并整块腋窝淋巴结清扫术(ALND)开始时,将专利蓝染料注入肿瘤。在切除的标本中,从原发性肿瘤到首个引流淋巴结(前哨淋巴结)解剖蓝色染色的淋巴管。
26例患者(87%)成功识别出前哨淋巴结(SN)。10例患者的SN为肿瘤阳性。其中6例患者,SN是唯一的肿瘤阳性淋巴结。未发生“跳跃式”转移。
本研究证实了淋巴扩散的循序渐进性质。如果在体内得到证实,这些数据可能会大幅减少对ALND的需求,而不影响生存率和区域控制,也不会丢失预后和分期信息。