Abstract：
Lymphatic dissemination is thought to be a rare event in breast sarcomas. The decision to perform axillary clearance is challenging. In our prospective cohort, we aimed to evaluate the frequency and factors determining lymph node (LN) involvement in breast sarcomas, with the aim of proposing a decision tree/algorithm for the realization of LN clearance in breast sarcomas.
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.
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.
摘要：
淋巴传播被认为是乳腺肉瘤中的罕见事件。进行腋窝清除的决定具有挑战性。在我们的前瞻性队列中，我们的目的是评估乳腺肉瘤淋巴结（LN）受累的频率和因素，目的是提出一种决策树/算法来实现乳腺肉瘤中的LN清除。
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。
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。
