1~2枚腋窝前哨淋巴结转移的乳腺癌患者非前哨淋巴结转移影响因素分析

目的探讨前哨淋巴结活组织检查(SLNB)后非前哨淋巴结(SLN)转移的影响因素。 方法回顾性分析2015年3月至2020年9月湖北省十堰市太和医院收治的837例双染料示踪法SLNB有1~2枚转移且行腋窝淋巴结清扫的乳腺癌患者资料,分为非SLN有转移组(54例)和无转移组(783例),采用χ²检验比较2组患者的肿瘤直径、病灶位置、脉管侵犯、病理类型、多发病灶、SLN转移灶类型、分子分型、ER、PR、HER-2、Ki-67等临床病理特征,采用秩和检验比较2组患者的组织学分级和SLN转移率。采用Logistic回归分析影响乳腺癌患者腋窝非SLN转移的危险因素。 结果2组患者的肿瘤直径、脉管侵犯、组织学分级、SLN转移率比较,差异均有统计学意义(χ²＝3.940、45.882,Z＝-2.225、-4.540,P＝0.047、<0.001、0.027、<0.001)。多因素分析结果显示：有脉管侵犯、SLN转移率≥50%且<100%和SLN转移率为100%均为影响非SLN转移的独立危险因素( OR ＝4.826,95%CI: 2.675~8.706,P <0.001;OR＝3.822,95%CI：1.538~9.501,P＝0.004;OR＝4.761,95%CI: 2.014~11.256,P<0.001)。 结论有脉管侵犯或SLN转移率≥50%的乳腺癌患者,非SLN转移的风险增加,应行腋窝淋巴结清扫术。     

乳腺癌前哨淋巴结微小转移的检测

前哨淋巴结(SLN)可以反映腋窝淋巴结的转移状况,检测SLN微小转移可以筛查出常规病理检查阴性中的高危患者,从而使治疗更加有的放矢。检测微小转移的方法有多层面切片、免疫组化染色和逆转录-聚合酶链反应(RT-PCR)。不同方法微小转移的检出率不同,其临床意义目前尚无定论；对于SLN有微小转移者,是否应清扫腋窝也在研究中。     

乳腺癌前哨淋巴结微小转移的检测

前哨淋巴结（SLN）可以反映腋窝淋巴结的转移状况,检测SLN微小转移可以筛查出常规病理检查阴性中的高危患者,从而使治疗更加有的放矢。检测微小转移的方法有多层面切片、免疫组化染色和逆转录．聚合酶链反应（RT-PCR）。不同方法微小转移的检出率不同,其临床意义目前尚无定论;对于SLN有微小转移者,是否应清扫腋窝也在研究中。     

乳腺癌前哨淋巴结微小转移的检测及其意义

近年来,前哨淋巴结活检 （ sentinel lymph node biopsy, SLNB）技术研究的不断深入以及临床应用的不断普及,已经改变了一个多世纪来腋窝淋巴结清除 （axillary lymph nodes dissection; ALND） 作为乳腺癌外科治疗重要组成部分的历史。欧美一些学者认为,SLNB达到甚至超过了ALND在乳腺癌治疗中的重要地位。但是,     

乳腺癌前哨淋巴结微转移的检测与临床意义

前哨淋巴结(SLN)活检能够准确评估区域淋巴结状态,为乳腺癌患者提供精确的分期,同时也减轻了淋巴结阴性患者的手术并发症.规范前哨淋巴结病理检测手段,充分利用分子生物学检测方法,有助于准确判断微转移.但前哨淋巴结的微转移在乳腺癌预后判断、治疗决策中的意义尚存争议.     

乳腺癌前哨淋巴结活检的研究体会

乳腺癌手术在历史上是肿瘤外科最具代表性的治疗 ,其手术方式 ,由经典根治手术到改良根治手术以及各种保留乳房的术式 ,体现了肿瘤外科思想观念的转变与方法的探索。最终目的为 :最大限度地追求良好的治疗效果 ,最大限度地降低复发率和并发症。近年来 ,关于前哨淋巴结活检技术的研究 ,正是这一探索的继续和延伸。作者曾在本刊 2 0 0 0年第 5期上发表了他们对 30例早期乳腺癌进行前哨淋巴结活检研究的报告 ,阳性检出率 96 .7% ;与腋窝淋巴结解剖的符合比较 ,准确性 93.3% ,灵敏度 88.9%。目前 ,此研究在国内尚属起步阶段 ,必将陆续出现更多的探索成果。这项研究的关键在 :前哨淋巴结是否能完全地、准确地反映腋窝淋巴结的状态 ,同时 ,如何才能安全地以其指导腋窝淋巴结解剖的选择。对此 ,尚需积累大量的临床资料 ,进行深入探索 ,以资佐证。     

前哨淋巴结活检术检测乳腺癌腋窝淋巴结转移的效果评价

区域淋巴结是否转移是影响乳腺癌患者预后的独立因素。临床已证实,对于腋窝淋巴结阴性乳腺癌患者,行常规腋窝淋巴结清除术(axillary lymph node dissection,ALND)无任何治疗意义,而且可引起许多并发症。乳腺癌前哨淋巴结     

乳腺癌前哨淋巴结微转移的非前哨淋巴结转移率探讨

目的：探讨乳腺导管内癌（DCIS）和浸润性导管癌前哨淋巴结（SN）微转移对非SN转移率的影响。方法：采用常规HE染色和CK19免疫组化法回顾性研究24例DCIS和41例浸润性导管癌患者的SN微转移和非SN转移情况。结果：对65例早期乳腺癌患者的103枚SN进行了研究。24例DCIS患者中，1例SN转移其非SN也有转移（4．2％），23例SN阴性的DCIS中未发现SN微转移；41例浸润性导管癌患者中，10例SN转移中6例有非SN转移；其余31例SN阴性患者中，CK19免疫组化法染色发现SN微转移4例（12．9％），其中1例患者有非SN转移；SN微转移患者中非SN转移率25．0％（1／4），SN转移患者中非SN转移率63．6％（7／11），多枚SN仅1枚微转移患者中的非SN转移率50．0％（1／2）。结论：初步研究提示，CK19免疫组化法检测SN微转移有助提高SN转移的发现，SN微转移患者若放弃腋淋巴结清除可能造成转移灶的残留。SN微转移的研究可作为腋淋巴结清除或放疗的一个参考指标。     

乳腺癌前哨淋巴结转移的诊断与预后

前哨淋巴结（sentinel lymph node, SLN）能准确反映乳腺癌患者腋窝淋巴结的状况。术后对SLN大体转移的诊断较为容易,对微转移和孤立肿瘤细胞（isolated tumor cells, ITC）的诊断通常依靠连续切片（逐层切片）HE染色和（或）免疫组化。准确而快速的术中诊断可以使SLN阳性者通过一次手术进行完全的腋淋巴结清除,目前常用的诊断方法为印片细胞学和快速冰冻病理诊断,而敏感性更高的分子诊断开始应用于SLN的诊断。     

乳腺癌前哨淋巴结微转移研究进展

目的:综述乳腺癌前哨淋巴结(SLN)微转移研究进展和临床应用价值.方法:以“乳腺癌、前哨淋巴结、微转移”为关键词,检索PubMed、万方医学网和中国知网数据库2003-2012年发表的相关文献,共检索到中文文献40条,英文文献226条.纳入标准:1)乳腺癌SLN微转移的病例对照和前瞻性研究;2)SLN微转移检测万法的研究;3)SLN微转移的研究现况.根据纳入标准,共纳入分析30条文献.结果:腋淋巴结阴性的早期乳腺癌,前哨淋巴结活检(SLNB)可以替代腋淋巴结清除术(ALND)判断腋淋巴结状态.连续切片(SS)方法、IHC技术和分子分析技术均可以增加微转移的检出率.SLN微转移可能代表了渐进性的病情进展和非前哨淋巴结转移的高风险性.结论:SLN微转移的临床意义存在争论,随着SLNB技术的成熟,可以提高阳性淋巴结的检出率,进一步提高SLN的预测能力.     

早期乳腺癌腋窝前哨淋巴结阳性患者腋窝非前哨淋巴结转移风险预测

目的 分析前哨淋巴结活检(SLNB)1~2个阳性乳腺癌患者中非前哨淋巴结(NSLN)转移的影响因素并构建预测模型。方法 回顾分析2008-2014年中国医学科学院北京协和医学院肿瘤医院未行新辅助化疗前哨淋巴结 1~2个阳性并行腋窝淋巴结清扫的乳腺癌患者的临床病理因素。计数资料组间比较采用χ²检验,多因素分析采用Logistic回归模型。以AUC值和校正曲线对Nomogram预测模型进行评估。结果 共 270例患者纳入研究,87例(32.2%)存在NSLN转移。中位年龄46(21~80)岁,中位SLN送检个数4(1~10)个,中位腋窝淋巴结清扫个数20(10~41)个。单因素分析结果显示病理分级、SLN宏转移、阳性SLN个数和阴性SLN个数是腋窝NSLN转移的影响因素(P=0.001~0.045)。多因素分析结果显示病理分级、阳性SLN个数和阴性SLN个数是NSLN转移的独立影响因素(P=0.000~0.041)。乳腺癌NSLN转移Nomogram预测模型AUC=0.70,当预测患者的NSLN转移率≤15%时,假阴性率仅为10.5%。结论 Nomogram预测模型可作为临床医师进行腋窝处理时的决策参考,对于NSLN转移概率低的患者可以避免行腋窝淋巴结清扫或腋窝放疗。     

原发性乳腺癌前哨淋巴结转移的影响因素分析

目的 探讨影响原发性乳腺癌前哨淋巴结转移（SLNM）的相关因素。方法 回顾性分析2008年1月至2014年12月北京市顺义区妇幼保健院乳腺中心收治的原发性乳腺癌且行前哨淋巴结活检的264例女性患者的临床病例资料。分析SLNM与临床病理特征的关系。结果 264例乳腺癌患者中,发生SLNM 59例。单因素分析显示,肿瘤大小、ER表达、HER-2表达均与SLNM有关（P＜0.05）。非条件Logistic回归分析显示,肿瘤大小及HER 2表达是影响SLNM的独立因素（均P＜0.05）。结论 肿瘤大小和HER-2表达是影响乳腺癌SLNM的独立因素,其他临床病理特征与SLNM的关系有待进一步研究。     

Validation of the Tenon breast cancer score for predicting non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastasis: a prospective multicenter study

Background Axillary lymph node dissection (ALND) is the standard treatment for patients with sentinel node (SN) metastasis, but most of these patients have negative non-sentinel nodes (non-SN). We have developed a scoring system (the Tenon score) to help identify a subgroup of patients who have a low risk of having non-SN metastases and who may thus forgo ALND. Here we validated the Tenon score in an independent cohort of SN-positive patients. Patients and methods We tested the accuracy of the Tenon score for predicting non-SN status in a prospective multicenter study of 226 SN-positive breast cancer patients. We calculated the false-negative rate, sensitivity, specificity, and positive (PPV) and negative predictive values (NPV). Receiver operating characteristics (ROC) curves were constructed and the areas under the curve (AUC) were calculated as a measure of discriminatory capacity. Results At least one non-SN was positive in 63 patients (27.9%). One hundred and twenty (53.1%) of the 226 patients had a Tenon score of 3.5 or less. Among these 120 patients, five had at least one positive non-SN. With a score cut-off of 3.5, the negative predictive value was 95.8% and the false-negative rate was 4.2%. Overall, the Tenon score accurately predicted non-SN status, with an AUC of 0.82 (95% confidence interval, 0.77–0.88). Conclusion In this multicenter study of an independent patient population, the Tenon score was accurate and reproducible for predicting non-SN status in breast cancer patients. The simplicity and reliability of the variables on which the Tenon score is based may be an advantage over other scoring systems.     

乳腺癌前哨淋巴结微小转移的检测

目的探讨检测乳腺癌前哨淋巴结(SLN)微小转移的最佳方法,研究临床病理因素与微小转移的相关性。方法应用同位素法检测乳腺癌SLN;对常规病理检查阴性的SLN,以100μm为间隔,进行多层间隔连续切片,并做HE和免疫组化染色检测微小转移;取肿瘤标本进行连续切片,并行免疫组化染色。结果共检测59例患者的121枚SLN和44份肿瘤标本,有14例(23.7%)患者的17枚(14.O%)SLN有微小转移。用HE染色法,切片数量从1层增加到3层时,微小转移的检出例数分别为3、7和10例;在3个层面上行间隔连续切片,HE分别与AE1/3、CK19和muc1联合检测时,微小转移的检出例数分别为14、12和16例。增加切片数量或采用联合检测的方法,可以提高微小转移的检出数量,微小转移与原发肿瘤大小、c-erbB2、MMP-2和血管内皮生长因子(VEGF)的表达相关。结论检测SLN微小转移的最佳方法为间隔100μm、在2个层面上行间隔连续切片,同时进行HE和muc1染色,可以检出绝大多数的微小转移。     

Prevalence of extracapsular extension in metastatic sentinel lymph nodes in breast cancer

IntroductionAxillary lymph node involvement is recognized as a key prognostic factor for invasive breast cancer. Retrospective analyzes have shown that extracapsular extension (ECE) is correlated with negative prognostic factors in this neoplasia.Objectiveto evaluate the measurement of ECE and its relationship with the number of affected non-sentinel lymph nodes, as well as to investigate the association between ECE with other clinical and pathological prognostic factors.MethodsThis is a cross-sectional observational study carried out from January 2015 to June 2019, at the Breast Surgical Oncology service of Liga Contra o Cancer (LIGA), in Natal, Brazil. A total of 150 patients were included in the study and were divided into three groups: absence of ECE, ECE less than or equal to 2 mm and ECE greater than 2 mm.ResultsThe mean age was 58 years for the group with ECE and 57 years for the group without ECE. Most of the patients were mixed race (66.7%), had no family history of breast cancer (64%) and underwent quadrantectomy (64.5%). Regarding the characteristics of the disease, most presented a histological report compatible with Invasive Carcinoma of the non-special type (IC NST) (87.5%), histological grade II (52.7%), negative Lymphovascular invasion (LVI) (52.7%), Tumor Size T1 (<2.0 cm) (52%) and Luminal B molecular subtype (36.7%). Regarding sentinel lymph nodes: 103 patients (68.7%) had ECE and 1 positive sentinel lymph node was identified in most cases. There was a statistically significant association between the presence of ECE and of being mixed race (p = 0.03), between ECE and LVI (p = 0.05) and between ECE and a greater number of positive non-sentinel lymph nodes (p < 0.001).ConclusionOur study showed that ECE> 2 mm is associated with increased axillary nodal load compared to groups without ECE and ECE ≤ 2 mm in sentinel node biopsy in patients who met the Z0011 criteria.     

Extra-axillary sentinel lymph nodes in breast cancer

Background  Extra-axillary locations are known sites of lymph node metastases in patients with carcinoma of the breast. Methods  A technique utilizing a gamma probe was used to identify hot spots representing sentinel nodes residing in either axillary or extra-axillary locations in 680 patients with operable, clinically node-negative breast cancer. All identified sentinel nodes were excised. Results  Results showed that extra-axillary hot spots were found in 6.5% of patients. This rate increased to 14.8% if patients were injected with 8.0 ml unfiltered Technetium-99m-Sulfur colloid. Extra-axillary metastatic disease was identified in 6.8% of patients with extra-axillary hot spots. In patients with extra-axillary drainage, pathologically-positive nodes were exclusive to extra-axillary sites (ie, no axillary metastases) in 4.5% of cases. Factors found to increase the likelihood of identifying extra-axillary hot spots included; an increased volume of injection, medial or central tumor locations and T3 primary tumors. Conclusion  Gamma probe-guided techniques can identify extra-axillary sentinel nodes, which are at risk for harboring metastatic disease. Removal of these nodes can be done with little morbidity and may improve staging in the individual patient.