Berclaz G, Crazzolara A O, Altermatt H J, Aebi S, Fey M F, Hänggi W, Dreher E
Universitäts-Frauenklinik, Inselspital Bern.
Schweiz Med Wochenschr. 1998 Oct 31;128(44):1730-6.
Axillary lymph node status is an important determinant of prognosis in breast cancer. However, lymphadenectomy does not benefit half of the patients in whom axillary nodes are free of disease. Sentinel lymph node biopsy is a new technique which allows accurate staging of breast carcinoma without performing total axillary dissection. We describe our experience with the introduction of sentinel lymphadenectomy.
Thirty-seven sentinel lymphadenectomies were performed in 35 patients referred to the Department of Obstetrics and Gynaecology of the University of Berne between December 1997 and June 1998. Mapping procedures were performed using a combination of vital blue dye with preoperative lymphscintigraphy with 99mTechnetium-labelled colloidal albumin and intraoperative use of a gamma probe. Complete axillary lymphadenectomy was then performed in 34 patients.
One or more lymph nodes were identified in 33 of 37 procedures (89%). With the combination of both localisation techniques the sentinel nodes were identified in all (100%) of the last 19 patients. Sentinel and non-sentinel lymph nodes were always concordant. In this series the negative predictive value is 100% (95% confidence interval: 87.7%-100%). Metastases were found in the sentinel node in 11 of 30 patients (37%). From these 11 patients, 3 (27%) had micrometastases.
Histopathologic examination of the sentinel lymph node accurately predicts the axillary lymph-node status. Patients with sentinel nodes free of metastases could avoid the unnecessary peri- and postoperative complications of complete axillary dissection. Further studies are needed to assess whether the improved diagnosis of micrometastases by sentinel lymphadenectomy influences the long-term prognosis of breast cancer.
腋窝淋巴结状态是乳腺癌预后的重要决定因素。然而，淋巴结清扫术对腋窝淋巴结无转移的患者中的半数并无益处。前哨淋巴结活检是一项新技术，可在不进行全腋窝清扫的情况下对乳腺癌进行准确分期。我们介绍我们引入前哨淋巴结清扫术的经验。
1997年12月至1998年6月期间，对伯尔尼大学妇产科转诊的35例患者进行了37例前哨淋巴结清扫术。采用活性蓝色染料与术前用99m锝标记的胶体白蛋白进行淋巴闪烁显像相结合的方法进行定位，并在术中使用γ探头。然后对34例患者进行了全腋窝淋巴结清扫术。
37例手术中有33例（89%）发现一个或多个淋巴结。在最后19例患者中，两种定位技术联合使用时，前哨淋巴结均被识别（100%）。前哨淋巴结和非前哨淋巴结始终一致。在本系列中，阴性预测值为100%（95%置信区间：87.7%-100%）。30例患者中有11例（37%）在前哨淋巴结中发现转移。在这11例患者中，3例（27%）有微转移。
前哨淋巴结的组织病理学检查可准确预测腋窝淋巴结状态。前哨淋巴结无转移的患者可避免全腋窝清扫带来的不必要的围手术期和术后并发症。需要进一步研究来评估前哨淋巴结清扫术对微转移的更好诊断是否会影响乳腺癌的长期预后。
