Sentinel lymph node biopsy in patients with Stage I/II melanoma: Clinical experience and literature review

BACKGROUND: The sentinel lymph node (sN) represents one of the most powerful predictors of the outcome of patients with Stages I and II cutaneous melanoma, and may be relevant for the therapeutic planning of early-stage melanoma patients. Since adopting the technique of lymphatic mapping with vital blue dye (Patent Blue-V) in July 1993, we have periodically up-dated the methodology and revised our results in order to define the contribution of radio-guided surgery (RGS) to the detection of the sN as well as the role of intraoperative frozen section examination of the sN. MATERIALS AND METHODS: Between July 1993 and December 1997, 180 patients with clinically node-negative primary cutaneous melanoma (Stages I-II) underwent sN biopsy followed by "selective lymph node dissection" (SLND) whenever sN metastasis was detected. Presently, complete data are available in 165 patients who were divided into two consecutive subsets of 39 and 126 patients, based on the technique for the identification of the sN: Patent Blue-V only or Patent Blue-V associated to RGS. Moreover, in this second subset of patients intraoperative frozen section findings were compared with definitive pathologic examination. RESULTS: As regards the first subset of 39 patients (17 males and 22 females; mean age 51.3 years), the sN was identified in 35 patients (89.7%); 8 patients (22.8%) were found to have metastatic melanoma cells in their sN, and they all underwent SLND of the affected basin. As regards the second set of 126 patients (54 males and 72 females; mean age 53.5 years), the sN was detected in every case by means of the combined technique (Patent Blue-V and RGS): in 4 of 126 patients (3.2%), the sN was detected by means of RGS only whereas in no patient was the sN detected by Patent Blue-V only. Frozen section examination was performed in 123 of 126 patients who had sN detection by Patent Blue-V and RGS, and the intraoperative examination had a sensitivity of 66.6% (22 of 33), specificity of 100% (90 of 90), negative predictive value of 89.1% (90 of 101), and accuracy of 91% (112 of 123). The benefit of frozen section examination in avoiding a two-stage procedure was 17.9% (22 of 123 patients). In patients with thicker lesions (pT(3)-pT(4)), the sensitivity and the benefit of intraoperative examination were 76% (19 of 25) and 32% (19 of 59 patients), respectively. CONCLUSIONS: Sentinel node lymphadenectomy can be better accomplished when both procedures (lymphatic mapping with Patent Blue-V and RGS) are used because the two methods look quite complementary. In fact, the use of the radiocolloid mapping allows to detect a hot spot in the regional basin prior to making the skin incision in order to perform a minimal invasive access, and it may also more accurately differentiate the true sN from a secondary echelon node (non-sN). The use of frozen section examination should be restricted to patients with pT(3)-pT(4) primary melanoma, due to the higher sensitivity and benefit in terms of avoiding a two-stage operative procedure.     

Technical issues and pathologic implications of sentinel lymph node biopsy in early-stage breast cancer patients

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated that the sentinel lymph node (sN) can be considered a reliable predictor of axillary lymph node status in breast cancer patients. However, some important issues, such as optimization of the technique for the intraoperative identification of the sN, and the clinical implications of sN metastasis as regards the surgical management of the axilla still require further elucidation. The objectives of this study was to assess (1) the feasibility of sN identification with a combined approach (vital blue dye lymphatic mapping and radioguided surgery, RGS) and the specific contribution of either techniques to the detection of the sN, and (2) the correlation between the size of sN metastasis (micrometastasis < or = 2 mm; macrometastasis > 2), primary tumour size, and the status of nonsentinel nodes (nsN) in the axilla. METHODS: Between October of 1997 and December of 1999, 212 patients with breast cancer (average age: 61 years; range, 40-79 years) underwent sN biopsy before performing standard axillary dissection. In a subset of 153 patients, both vital blue dye (Patent Blue-V) lymphatic mapping and RGS were used to identify the sN, and the relative contribution of each of the two techniques was assessed. RESULTS: Overall, the sN was identified in 206 of 212 patients (97.1%); at histologic examination of all dissected nodes, 77 of 206 patients had positive nodes (37.3%). The false-negative rate was 6.5% (5/77), the negative predictive value was 96.3% (129/134), and accuracy was 97.6% (201/206). Among 72 patients with positive sN, micrometastases were detected in 21 cases and macrometastases in 51. When micrometastases only were observed, the sN was the exclusive site of nodal metastasis in 17 of 21 cases (80.9%); in the remaining 4 cases (19.1%), nsN metastases were detected in 3 of 14 pT1c patients (21.5%), and 1 of 5 pT2 patients (20%). Macrometastases were detected in patients with tumors classified as pT1b or larger: the sN was the exclusive site of metastasis in 3 of 4 pT1b patients (75%), in 14 of 29 pT1c patients (48.2%), and in 3 of 18 pT2 patients (16.6%). The specific contribution of the two different techniques used in the identification of the sN was evaluated; the detection rate was 73.8% (113 of 153) with Patent Blue-V alone, 94.1% (144 of 153) with RGS alone, and 98.7% (151 of 153) with Patent Blue-V combined with RGS (P < 0.001). Noteworthy, whenever the sN was identified, the prediction of axillary lymph node status was remarkably similar (93-95% sensitivity; 100% specificity; 95-97% negative predictive value, and 97-98% accuracy) with each of the three procedures (Patent Blue-V alone, RGS alone, or combined Patent Blue-V and RGS). CONCLUSIONS: Sentinel lymphadenectomy can better be accomplished when both procedures (lymphatic mapping with vital blue dye and RGS) are used, due to the significantly higher sN detection rate, although the prediction of axillary lymph node status remains remarkably similar with each one of the methods assessed. That patients with small tumours (<1 cm) and sN micrometastasis are very unlikely to harbour metastasis in nsN should be considered when planning randomised clinical trials aimed at defining the effectiveness of sN guided-axillary dissection.     

The prognostic role of the sentinel lymph node in clinically node-negative patients with cutaneous melanoma: experience of the Genoa group

AIM: To define the benefit of intraoperative frozen section examination of the sentinel lymph node (sN), and to assess its prognostic value in clinically node-negative melanoma patients. MATERIALS AND METHODS: Between July 1993 and December 2001, 214 patients with Stage I-II cutaneous melanoma underwent sN biopsy; complete follow-up data are available in 169 of 175 patients who underwent preoperative lymphoscintigraphy, lymphatic mapping with Patent Blue-V and radio-guided surgery (RGS). RESULTS: In an initial subset, the sN was identified in 35 out of 39 patients; in the principal group of 169 patients, the sN was detected in all patients. The benefit of frozen section examination, that is the proportion of all patients having intraoperative histologic examination who tested positive, was 17.2% (29/169); notably, in patients with pT(1-2) vs pT(3-4) melanoma the corresponding values were 2.3 and 33.3%, respectively, (P=0.000). Cox regression analysis for overall survival indicated that sN-positive patients had a two-fold increased risk of death; the most significant predictors of relapse-free survival were sN status (P=0.004), age (P=0.015), and T stage grouping (P=0.033). CONCLUSIONS: The sN is a reliable predictor of regional lymph node status in patients with cutaneous melanoma. Frozen section examination can be useful in avoiding a 'two-stage' operative procedure in patients with tumour-positive sN, but its greatest benefit seems to be restricted to patients with pT(3)-pT(4) primary melanoma.     

Sentinel lymph node mapping in early-stage breast cancer: technical issues and results with vital blue dye mapping and radioguided surgery

BACKGROUND AND OBJECTIVES: Axillary lymph node status is the most important prognostic factor in patients with operable breast cancer. Recent studies have demonstrated the possibility of identifying the sentinel lymph node (sN) as a reliable predictor of axillary lymph node status in both cutaneous melanoma and breast cancer. Sentinel lymph node identification proved feasible by either peritumoral dye injection (Patent Blue-V) or radiodetection, with identification rates of 65-97% and 92-98%, respectively. However, some important issues need further definition, namely (a) optimization of the technique for intraoperative detection of the sN, (b) predictive value of the sN with regard to axillary lymph node status, and (c) reliability of intraoperative histology of the sN. We reviewed our experience in sN detection in patients with stage I-II breast cancer to assess the feasibility and accuracy of lymphatic mapping, by vital blue dye or radioguided surgery, and sN histology as a predictor of axillary lymph node status. METHODS: Two groups of patients (55 and 48) were recruited between May 1996 and May 1997 and between October 1997 and February 1998; the patients of the first series underwent vital blue dye lymphatic mapping only, whereas those of the second series had a combined approach with both vital blue dye mapping and radioguided detection of the sN. RESULTS: In the first set of patients, the sN was identified in 36/55 patients (65.4%); sN histology predicted axillary lymph node status with a 77% sensitivity (10/13), a 100% specificity (23/23), an 88.5% negative predictive value (23/26), and an overall 91.5% accuracy (33/36). The sN was the quasi-elective site of lymph node metastases because in clinically N0 patients nodal involvement was 20-fold more likely at histology in sN than in non-sN (30% and 1.5%, respectively). In the second set of patients, 49 lymphadenectomies were performed because 1 patient had bilateral breast cancer; the sN was identified in 45/49 lymphadenectomies (92%). The sN was intraoperatively negative at frozen-section examination in 33 cases, and final histology confirmed the absence of metastases in 31/33 cases (94%), whereas in 2 cases (6%) micrometastases only were detected. Final histology of the sN predicted axillary lymph node status with an 87.5% sensitivity (14/16), a 100% specificity (29/29), a 93.5% negative predictive value (29/31), and an overall 95.5% accuracy (43/45). CONCLUSIONS: Sentinel lymphadenectomy can be better accomplished when both mapping techniques (vital blue dye and radioguided surgery) are used. In this group of patients, agreement of intraoperative histology of the sN with the final diagnosis was 94%, and sN histology accurately predicted axillary lymph node status in 43/45 lymphadenectomy specimens (95.5%) in which an sN was identified.     

The role of axillary lymph node dissection in breast cancer patients with sentinel lymph node micrometastases.

AIM: To identify by means of clinical and histopathological features a subset of breast cancer patients with sentinel lymph-node (sN) micrometastases and metastatic disease confined only to the sN in order to spare them an unnecessary axillary lymph node dissection (ALND). MATERIALS AND METHODS: From January 1998 to December 2004, 116 patients with sN micrometastases underwent standard ALND for early-stage (T1-2 N0 M0) invasive breast cancer; clinical and histopathologic parameters were prospectively collected and evaluated by means of univariate and logistic regression analysis in order to identify which patients with sN micrometastases were free of metastasis in axillary non-sN. RESULTS: Sixteen of 116 patients with sN micrometastases had tumour involvement of non-sN, with six and 10 patients having non-sN micrometastases and macrometastases, respectively. None of 19 patients with primary tumour measuring 相似文献   

Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients.

BACKGROUND: Routine histologic examination of axillary sentinel lymph nodes predicts axillary lymph node status and may spare patients with breast carcinoma axillary lymph node dissection. To avoid the need for two separate surgical sessions, the results of sentinel lymph node examination should be available intraoperatively. However, routine frozen-section examination of sentinel lymph nodes is liable to yield false-negative results. This study was conducted to ascertain whether extensive intraoperative examination of sentinel lymph nodes by frozen section examination would attain a sensitivity comparable to that obtained by routine histologic examination without intraoperative frozen section examination. METHODS: In a consecutive series of 155 clinically lymph node negative breast carcinoma patients, the axillary sentinel lymph nodes were examined intraoperatively, before complete axillary lymph node dissection. The frozen sentinel lymph nodes were sectioned subserially at 50-microm intervals. For each level, one section was stained with hematoxylin and eosin and the other section immunostained for cytokeratins using a rapid immunocytochemical assay. RESULTS: Sentinel lymph node metastases were detected in 70 of the 155 patients (45%). In 37 cases the sentinel lymph nodes were the only axillary lymph nodes with metastases. Immunocytochemistry did not increase the sensitivity of the examination. Five patients had metastases in the nonsentinel axillary lymph nodes despite having negative sentinel lymph nodes. The general concordance between sentinel and axillary lymph node status was 96.7%; the negative predictive value of intraoperative sentinel lymph node examination was 94.1%. CONCLUSIONS: The intraoperative examination of axillary sentinel lymph nodes is effective in predicting the axillary lymph node status of breast carcinoma patients and may be instrumental in deciding whether to spare patients axillary lymph node dissection.     

The value of intraoperative frozen section examination of sentinel lymph nodes in breast cancer

Background

Sentinel node biopsy is a standard diagnostic component for the treatment of patients with a primary mammary carcinoma. By concomitantly performing intraoperative lymph node biopsy and primary tumor resection, patients with a positive sentinel node (SN) are not subjected to the inconvenience and risks of second surgical intervention. The aim of this retrospective study was to determine the sensitivity, accuracy and long-term consequences of the frozen section (FS) examination of the SN in breast cancer patients.

Methods

Sentinel lymph node biopsy was performed in 615 patients with an invasive tumor of the breast. Frozen sections of the SN were taken from the optimal cross-sectional surface. Serial sections were made from the remaining SN and stained using hematoxylin–eosin and immunohistochemistry.

Results

Sentinel node frozen biopsy accurately predicted the state of the axilla in 559 (90.7%) patients. There were 50 false-negative findings in patients with sentinel node metastases. The sensitivity and specificity of the intraoperative frozen section examination were 71.6% and 100%, respectively. Follow-up (mean 36.3 months) of all false-negative cases showed no development of local axillary recurrence. The results demonstrated no significant relation between tumor size and frozen section sensitivity. Frozen section investigation was less sensitive in ascertaining micrometastases (sensitivity 61.1%) than macrometastases (sensitivity 84.0%, p < 0.001).

Conclusion

Intraoperative frozen section examination of the sentinel node is a useful predictor of axillary lymph node status in breast cancer patients. Seventy-two percent of the patients with metastatic disease were correctly diagnosed and spared a second surgical procedure.     

乳腺癌前哨淋巴结定位和活检

目的：难证乳腺癌前哨淋巴结定位和活检技术的可行性和前哨淋巴结的组织状况能否准确预告腋淋巴结的状况。方法：本研究使用专利蓝,对３３例乳腺癌患者进行了术中及术后前哨淋巴结定位和活检术。结果：３０例（９１％）找到前哨淋巴结,前哨淋巴结预告腋淋巴结的准确率为９６．７％,假阴性１例。结论：本研究结果证实,乳腺癌前哨淋巴结定位和活检技术是可行的,前哨淋巴结的组织学特征能够准确反映腑淋巴结的状况。我们相信在将来     

染料法前哨淋巴结活检在乳腺癌手术中的应用价值

目的探讨前哨淋巴结活检（SLNB）在乳腺癌手术中的临床应用价值。方法采用亚甲蓝作为示踪染料对乳腺癌开展SLNB，并且对术中冰冻检查前哨淋巴结（SLN）阴性的病例分组施行部分腋窝淋巴结清扫术（PALND）及常规全腋窝淋巴结清扫（TALND），观察术后并发症、生存率等指标并比较分析。结果SLN检出率97．6％，假阴性率14．3％；接受PALND组术后并发症发生率明显低于传统的TALND组，差异有统计学意义（P〈0．05），而总生存率间的差异无统计学意义（P〉0．05）。结论腋区SLNB能准确反映乳腺癌腋窝淋巴转移状态，为临床缩小乳腺癌手术范围和减少术后并发症提供重要参考价值。     

Sentinel lymph node biopsy and axillary lymph node dissection

Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary status and obviating axillary dissection in patients with node-negative breast cancer. A combination of dye- and gamma probe-guided methods can identify SLN more accurately and easily than either of these techniques alone. On the other hand, SLN biopsy is highly accurate and sensitive in patients with small tumors, and no false-negative SLN biopsy has been reported for a breast cancer < 1.0-1.5 cm. Moreover, extensive intraoperative examination of SLNs using frozen sections can attain a sensitivity comparable to that obtained by histologic examination on the permanent sections. In practice, therefore, axillary dissection can be avoided in patients with small tumors in whom the SLNs are negative.     

Value of rapid biopsy studies in the intraoperative assessment of axillary lymph node involvement in breast cancer

In a prospective, randomized trial in breast-cancer patients, the surgical procedure and the adjuvant regimen were determined intraoperatively, depending on the axillary lymph node involvement. Therefore, it was necessary to perform frozen section examinations on axillary lymph nodes. In this context it was important to analyze the value of the frozen section technique of lymph nodes in predicting axillary node involvement. In 162 patients with primary breast cancer we compared the results of the frozen sections and the paraffin histology. In 96% the intraoperative diagnosis was correct and in 4% (7 cases) the results were wrong. In 6 cases we observed a sampling error and in one case a small metastasis was misinterpreted as sinus histiocytosis. In these 7 cases less than 4 lymph nodes were examined in frozen sections and the total axillary node involvement was small (less than 4 involved nodes). There was no false positive report in this series. We conclude that frozen section examinations of axillary lymph nodes are suitable for intraoperative lymph node assessment, if at least 4 of the macroscopically most suspicious lymph nodes are observed. The final histological axillary staging (number of involved lymph nodes) has to be performed on paraffin-embedded material.     

乳腺癌术中前哨淋巴结印片细胞学的评估

乳腺癌的手术治疗发生了巨大的变化,前哨淋巴结活检是其中之一。前哨淋巴结活检可准确评估区域淋巴结状态,从而避免在腋淋巴结阴性乳腺癌中行腋淋巴结清扫术,减少手术的并发症。乳腺癌前哨淋巴结术中病理学诊断是目前限制前哨淋巴结发展成为乳腺癌的手术规范的主要原因之一,如果能够进行准确地术中诊断,就可以避免再次手术。本文对乳腺癌前哨淋巴结的术中诊断的两种主要方法印片细胞学与冷冻切片的优缺点进行比较,回顾相关机构进行术中诊断的研究结果,并且对印片对诊断前哨淋巴结中存在的问题以及可能改进的方向进行初步的探讨。     

Intraoperative histologic assessment of surgical margins and lymph node metastasis in breast-conserving surgery

The diagnostic value of intraoperative histologic examination of frozen sections of surgical margins and axillary lymph nodes (AX) was investigated in 95 patients with breast cancer who underwent breast-conserving surgery. The periphery of the excised breast tissue was peeled like an orange and examined histologically by frozen section. The results were compared with examination by permanent section. Evaluation of surgical margins by frozen section resulted in a diagnostic accuracy of 87%, a sensitivity of 96%, and a specificity of 84%. Enlarged or hardened AXs were sampled from the axillary pad which was derived from a complete AX dissection. Histologic examination using frozen section was performed during surgery. After the operation, the remaining AXs were removed from the axillary pad by hand dissection and histologically examined on permanent section. A diagnostic accuracy of 97%, a sensitivity of 77%, and a specificity of 100% were achieved in the diagnosis of AX involvement on frozen section. It was therefore concluded that intraoperative histologic examination of frozen sections may be useful in the determination of involvement of the surgical margins and the AXs in patients with breast cancer. © 1995 Wiley-Liss, Inc.     

Reliability of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients

Purpose

Sentinel lymph node biopsy (SLNB) is an accurate and effective means of axillary nodal staging in early breast cancer. However its indication after neoadjuvant chemotherapy (NAC) is under constant debate. The present study evaluates the reliability of SLNB in assessing axillary nodal status after NAC.

Methods

Data from 281 patients who had received NAC and subsequent SLNB were reviewed. The identification and false negative rates of SLNB were determined and the clinicopathologic factors associated with false negative results were investigated using univariate analysis.

Results

The identification rate of SLNB after NAC was 93.6% and the false negative rate was 10.4%. Hormone receptor status, especially progesterone receptor positivity, was significantly associated with false negative results. The accuracy of intraoperative frozen section examination of sentinel lymph nodes was 91.2%.

Conclusion

The identification rate of SLNB and the accuracy of intraoperative frozen section examination after NAC are comparable to the results without NAC in patients with early breast cancer. However considering the high false negative rates, general application of SLNB after NAC should be avoided. Patients with progesterone-positive tumors and non-triple-negative breast cancers may be a select group of patients in whom SLNB can be employed safely after NAC, but further studies are necessary.     

乳腺癌哨位淋巴结临床意义的研究

目的 :探讨一种在不降低乳腺癌分期准确性的前提下缩小手术的范围的腋窝淋巴结手术方法。方法 :使用专利蓝和美蓝对 1999年 4月～ 2 0 0 0年 4月我院外科收治的 73例临床查体腋窝淋巴结阴性的乳腺癌患者进行哨位淋巴结活检术 (sentinellymphnodebiopsy ,SLNB)。结果 :共成功地确定了 71例( 97.7% )患者的哨位淋巴结 (SLN) ,SLNB的假阴性率为 11.5% ,准确率为 95.8%。患者的年龄、肿瘤大小、肿瘤部位、注射的染料类型及是否活检和术前化疗对成功率和假阴性率无影响。术中印片细胞学检查的准确率为 92 .1% ,假阴性率为 10 % ,假阳性率为 7.1% ;术中快速病理检查准确率为 98 7% ,假阴性率为 5% ,假阳性率为 0 %。免疫组化未发现常规病理检查阴性的SLN有阳性结果。结论 :SLNB能够准确的预测腋窝淋巴结的转移状况 ,在缩小手术范围、减轻患者术后并发症的同时 ,保证了腋窝淋巴结分期的准确性 ;美蓝与专利蓝相比同样可以成功地确定SLN ;术中快速病理检查和印片细胞学检查可以准确的判断SLN的病理状态 ,但也存在一定的假阴性率     

ROC曲线评估超声造影对三阴性乳腺癌腋窝淋巴结的诊断价值

目的:分析对比增强超声造影对三阴性乳腺癌TAC化疗前腋窝淋巴结状态的评估价值,并采用ROC曲线评估其诊断腋窝淋巴结转移的价值。方法:选择2016年3月-2018年5月在本院诊治的86例三阴性乳腺癌患者作为研究对象,所有患者在进行化疗前均进行对比增强超声造影检查,以术后病理诊断结果为金标准,分析对比增强超声造影评估腋窝淋巴结转移的敏感性和特异性,比较腋窝淋巴结转移和未转移患者的对比增强超声造影检查参数,以淋巴结实质内高灌注区和低灌注区的差异度（SImax-SImin）做ROC曲线,分析对比增强超声造影对患者腋窝淋巴结转移的诊断价值。结果:病理检查结果腋窝淋巴结转移41例;对比增强超声造影检查结果34例腋窝淋巴结转移,52例未见淋巴结转移,其中假阳性2例,假阴性9例,其评估乳腺癌腋窝淋巴结转移的敏感性为78.05％,特异性为95.56％,阳性预测值为94.12％,阴性预测值为82.69％;腋窝淋巴结转移组SImax-SImin显著大于淋巴结未转移组,当SImax-SImin大于临界值20.96时,对比增强超声造影鉴别乳腺癌腋窝淋巴结转移的敏感性为85.29％,特异性为80.77％。结论:对比增强超声造影在三阴性乳腺癌TAC化疗前腋窝淋巴结状态评估和淋巴结转移诊断中具有较高的敏感性和特异性,可用于临床指导三阴性乳腺癌治疗方式及腋窝手术方式。     

Detection of micrometastases in sentinel lymph nodes of the breast applying monoclonal antibodies AE1/AE3 to pancytokeratins

Sentinel lymph node excision in breast cancer is a minimally invasive diagnostic procedure for accurate staging of the axilla and for avoiding unnecessary axillary dissection. In patients with palpable breast cancer we injected microcolloidal particles of human serum albumin labelled with technetium-99m the day before surgery. The sentinel node was detected intraoperatively with a handheld gammaprobe and then removed. Complete axillary dissection was performed and the nodes inspected by routine histological examination. The axillary lymph node status was correctly predicted by the sentinel node technique in 32 of 33 breast cancer patients. Two cases of micrometastases escaped routine histopathological detection but were identified by immunohistochemical analysis applying the antibody AE1/AE3 to pancytokeratins. Immunohistochemical examination of the sentinel node improves the diagnostic security of patients with breast carcinoma by detection of micrometastases.     

术前血清血管内皮生长因子对乳腺疾病的鉴别诊断意义

目的探讨术前血清血管内皮生长因子(sVEGF)对乳腺疾病的鉴别诊断意义。方法收集苏州大学附属第一医院甲乳外科2018年7月至2018年12月收治的110例乳腺癌(恶性组)和47例乳腺良性疾病(良性组)患者术前血液标本,比较恶性组与良性组间sVEGF水平的差别,分析乳腺癌患者不同临床特征间sVEGF水平的差别。采用Pearson线性相关分析乳腺癌患者sVEGF与其他指标的相关性。绘制受试者工作特征曲线评价乳腺癌患者sVEGF、术前腋窝B超及sVEGF联合术前腋窝B超对腋窝淋巴结转移的预测价值。结果恶性组与良性组间sVEGF水平差异无统计学意义(8053 vs. 7541,Z=-0646,P=0518);乳腺癌有腋窝淋巴结转移患者的sVEGF水平高于无腋窝淋巴结转移患者(6595 vs. 4976),差异有统计学意义(Z=-2546,P=0011)。不同临床分期乳腺癌患者的sVEGF水平差异有统计学意义,Ⅳ期高于Ⅰ期（9700 vs. 4823),Ⅲ期高于Ⅰ期（7309 vs. 4823),差异均有统计学意义(P<005);乳腺癌患者的sVEGF水平与血小板水平呈正比(r=0241,P=0036)。sVEGF联合术前腋窝B超诊断腋窝淋巴结是否有转移的诊断效能最高,其工作特征曲线下面积(AUC)为0797。结论术前sVEGF水平对乳腺良恶性疾病无鉴别诊断意义,但对乳腺癌患者有无腋窝淋巴结转移及判断临床分期有诊断意义。     

Is Necessary Intraoprative Frozen Section In Sentinel Lymph Node Biopsy For Breast Cancer Patients?

Background: Improvements in the process of staging and surgical treatment of axillary lymph nodes in recent years, have led to the use of intra operative frozen section pathology to examine the sentinel lymph node biopsy in breast cancer patients. Materials and Methods: we evaluated the results of the Sentinel biopsy in 102 patients with early stage breast cancer, which were negative clinical lymph nodes, and analyzing the true positive and false negative rate, diagnostic accuracy of frozen section lymph node biopsy. It also studied the factors affecting the sentinel and non-sentinel lymph nodes in patients treated by axillary lymph dissection. Results: In this study, we investigated 102 patients’ stage 1and 2 breast cancer with clinical negative axillary lymph node and candidates for sentinel lymph node biopsy, were placed under investigation. 15.7 % of the real positive results of sentinel and 62.7 % of the real negative and 2 % false positives and 20.9 % false negative results and% 78. 4 diagnostic accuracy, has been frozen section. Among the patients who were initially or delayed in the axillary dissection, 37% had more than two lymph nodes. While in general, 16.7% of patients had a need for axillary lymph node dissection based on z11 criteria. Lymph-vascular invasion was a major contributor to lentil involvement in Sentinel and non-Sentinel nodes. Conclusion: Frozen section pathology during the operation of sentinel lymph node biopsy has been initiated to prevent the need for a reoperation in early stage breast cancer patients. However, due to low tumor burden in patients who are candidates for this procedure, and the constraints in the initial sections and their false negative results, also the removal of frozen section will not have an effect on the rate of increasing reoperation and can be effective in reducing the time and cost of surgery.     

Lack of efficacy of xeroradiography to preoperatively detect axillary lymph node metastases in breast cancer

Xeroradiography of the axilla was performed in 132 patients with operable breast cancer to investigate the status of the axillary lymph nodes. Pathologic findings were correlated with the results of clinical examination and xeroradiographic findings. Xeroradiography does not appear to have improved our ability to identify axillary lymph node metastases in patients with breast cancer.