METHODS: Fourty-five women were surgically treated for breast sarcomas from 1982 to 2020. Angiosarcomas and other sarcomas were compared in terms of LN involvement, recurrence, and mortality.
RESULTS: Twenty-three patients underwent axillary lymphadenectomy. Initial LN involvement was diagnosed in one case of D2-40 positive, primary angiosarcoma for which preoperative imaging detected a suspicious LN confirmed by preoperative histology. Among the 22 patients who had no initial axillary lymphadenectomy, two patients with D2-40 positive angiosarcoma had recurrent cancer in LN (internal mammary group in 1 and homolateral axilla in 1). The average follow-up in the overall population was 6.2 years (±8.3). The cohort\'s overall recurrence rate was 33% (15/45) and the time of recurrence after initial surgery was on average 2.4 years (±3.1). For the three patients with LN metastases, time to recurrence after surgery was 3.7 years (±4.5). There was no significant difference in the overall recurrence rate depending on whether or not lymphadenectomy was initially performed (respectively 26% vs 41% OR=1.11, P=0.29).
CONCLUSIONS: Systematic axillary clearance leads to overtreatment in breast sarcomas. A decision tree, including radiological examination of the axilla, histological type of sarcoma, and D2-40 positivity, could be a decision aid in the choice of axillary clearance.
方法:从1982年到2020年,45名妇女接受了手术治疗。在LN受累方面比较了血管肉瘤和其他肉瘤,复发,和死亡率。
结果:23例患者接受了腋窝淋巴结清扫术。在1例D2-40阳性病例中诊断出最初的LN受累,术前影像学检查发现可疑LN的原发性血管肉瘤。在22例没有初次行腋窝淋巴结清扫术的患者中,2例D2-40阳性血管肉瘤患者在LN中复发癌(内乳组1例,同侧腋下组1例).总体人群的平均随访时间为6.2年(±8.3)。该队列的总复发率为33%(15/45),初次手术后的平均复发时间为2.4年(±3.1)。对于三名LN转移患者,术后复发时间为3.7年(±4.5).根据最初是否进行淋巴结清扫术,总复发率没有显着差异(分别为26%vs41%OR=1.11,P=0.29)。
结论:系统腋窝清除导致乳腺肉瘤过度治疗。决策树,包括腋窝的放射学检查,肉瘤的组织学类型,和D2-40阳性,可能是选择腋窝间隙的决策辅助。