背景:前哨淋巴结(SLN)活检是评估乳腺癌患者腋窝状态的金标准。在满足Z0011标准的情况下,不需要进一步的手术,而在其余情况下,需要腋窝清扫。该研究的目的是评估原发性乳腺肿瘤或SLN阳性的形态学和分子参数可以预测非前哨淋巴结(NSLN)的阳性,以避免不必要的腋窝淋巴结清扫术。方法:我们对170例连续浸润性乳腺癌进行了回顾性研究,进行SLN活检进行分期。结果:42例(24%)出现SLN转移,其中11个是微转移,6例符合Z0011标准,不需要后续手术。25名患者接受了随后的ANLD,但只有7例(28%)NSLN阳性。在这个系列中,只有肿瘤直径20mm可以预测阳性的非前哨淋巴结(p=0.058;CI:0.05787至0.8224)。其他参数,如患者年龄(p=0.280;CI:0.7544至7.998),组织学类型(p=0.231;CI:0.05374至9.271),组织学分级(p=0.929;CI:0.2351至3.515),肿瘤的分子谱(p=0.362;CI:0.2416至4.663),正SLN的数量(p=0.378;CI:0.1083至1.570),存在囊外延伸(p=0.625;CI:0.5066~13.96)和淋巴结比率(p=0.656;CI:0.5068~5.768)不能预测NSLN中存在转移.结论:在患者不符合Z0011标准和/或未使用这些标准的情况下,腋窝淋巴结清扫术是首选的手术治疗方法。
Background: Sentinel lymph node (SLN) biopsy is the gold standard in the evaluation of the axillary status in patients with breast cancer. In cases meeting the Z0011 criteria, no further surgery is needed, while in the remaining cases axillary dissection is required. The aim of the study was to evaluate which morphological and molecular parameters of primary breast tumor or positive SLN can predict the positivity of nonsentinel lymph nodes (NSLN) in order to avoid unnecessary axillary lymphadenectomy. Methods: We conducted a retrospective study on 170 consecutive invasive breast carcinomas, in which SLN biopsy was performed for staging. Results: 42 (24%) cases presented SLN metastases, of which 11 were micrometastases, 6 cases met the Z0011 criteria, requiring no subsequent surgery. 25 patients underwent subsequent ANLD, but only 7 cases (28%) had positive NSLN. In this series, only the tumor diameter 20 mm can predict positive nonsentinel lymph nodes (p= 0.058; CI: 0.05787 to 0.8224). Other parameters such as patient\'s age (p=0.280; CI:0.7544 to 7.998), histological type (p=0.231; CI: 0.05374 to 9.271), histological grade (p=0.929; CI: 0.2351 to 3.515), molecular profile of the tumor (p=0.362; CI: 0.2416 to 4.663), number of positive SLN (p=0.378; CI: 0.1083 to 1.570), presence of extracapsular extension (p=0.625; CI: 0.5066 to 13.96) and lymph node ratio (p=0.656; CI: 0.5068 to 5.768) cannot predict the presence of metastasis in the NSLN. Conclusion: In cases in which the patient does not meet the Z0011 criteria and/or these criteria are not used, axillary lymph node dissection is the surgical treatment of choice.