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。     

前哨淋巴结阳性乳腺癌患者的临床病理特征与非前哨淋巴结转移的关系

目的探讨腋窝前哨淋巴结(SLN)阳性乳腺癌患者的临床病理特征与非前哨淋巴结(n SLN)转移的关系。方法回顾性分析2007年1月至2013年7月广东省妇幼保健院乳腺病中心379例临床分期为T1-2N0M0期、行SLN活组织检查之后完成腋窝淋巴结清扫的乳腺癌患者资料,其中,SLN转移(SLN+)患者共125例,包括70例n SLN转移者(n SLN+组)和55例n SLN未转移者(n SLN-组)。应用χ2检验及Logistic Regression模型逐步回归法分析临床病理特征与n SLN转移的关系。结果 44%(55/125)SLN阳性患者的腋窝淋巴结转移仅限于SLN。单因素分析显示,n SLN转移与原发肿瘤直径、淋巴结外转移、阳性SLN数目、ER和PR状态有关(Z=-2.075,P=0.038;χ2=8.545,P=0.003;χ2=4.344,P=0.037;χ2=4.216,P=0.040;χ2=6.186,P=0.013)。多因素分析显示,淋巴结外转移、阳性SLN数目≥2枚、PR(+)为n SLN转移的独立影响因素(OR=4.114,95%CI:1.550~10.919,P=0.005;OR=2.454,95%CI:1.027~5.867,P=0.043;OR=0.370,95%CI:0.165~0.832,P=0.016)。结论淋巴结外转移、阳性SLN数目≥2枚及PR(+)的SLN阳性乳腺癌患者更容易发生n SLN转移。     

预测乳腺癌非前哨淋巴结转移的临床意义

 目的 寻找与乳腺癌非前哨淋巴结(sentinel lymph node，SLN)转移相关的指标，预测非SLN是否有转移，避免对腋窝淋巴结无转移的患者进行腋窝清扫。方法 回顾性分析从1999年5月到2004年2月完成的116例乳腺癌SLN活检病例，应用统计软件SPSS10．0对10种临床因素进行单因素和多因素分析，研究哪些因素与非SLN转移相关。结果 原发肿瘤大于2cm，脉管浸润，PerbB2(+)这3个因素与非SLN转移相关。具有其中一个因素时，非SLN转移机率为91％～95％，具有其中两个因素时为94％～100％，三个因素均具有时为100％。结论 非SLN转移的预测和SLN活检相结合，可以使转移仅局限于SLN的患者免除腋窝清扫，使治疗更加有的放矢。     

前哨淋巴结阳性早期乳腺癌非前哨淋巴结的组织学检测及临床意义

目的：研究早期乳腺癌患者前哨淋巴结(SLN)阳性时非前哨淋巴结(NSN)转移的可能性及其临床意义。方法：对84例SLN阳性接受乳癌根治术的早期乳腺癌患者的NSN及HER-2免疫组化等进行检测，分析NSN转移的发生率及相关临床因素。结果：SLN阳性患者NSN转移的检出率是48．8％(41／84)，NSN转移与原发肿瘤的大小、SLN转移灶的大小及HER-2的表达状况有关，原发肿瘤直径小于1cm及SLN转移灶小于1mm时NSN无转移，NSN的阳性率随原发肿瘤及SLN转移灶直径的增大而提高，HER-2蛋白阳性者NSN转移率高。结论：原发肿瘤直径小于1cm且SLN转移灶小于1mm时的早期乳腺癌患者可免于腋窝清扫，反之亦然；HER-2阳性患者NSN转移率较高，应考虑腋窝清扫。     

1个前哨淋巴结阳性乳腺癌患者的腋窝非前哨#br# 淋巴结转移情况及危险因素分析#br#

目的研究1个前哨淋巴结阳性的乳腺癌患者腋窝非前哨淋巴结（NSLN）转移情况及危险因素,为该类患者豁免腋窝淋巴结清扫（ALND）提供指导。方法选取2013年1月至2020年12月在哈尔滨医科大学附属肿瘤医院行前哨淋巴结活检（SLNB）证实仅有1个前哨淋巴结阳性且行ALND的乳腺癌患者465例,根据其腋窝NSLN转移情况,分为NSLN转移组104例,NSLN未转移组361例。比较两组的一般资料,采用二元Logistic回归分析腋窝NSLN转移的独立影响因素。结果465例仅1个前哨淋巴结转移的乳腺癌患者中,104例（224%）发生腋窝NSLN转移。其中,多个亚组患者的腋窝NSLN转移率<10%,如肿瘤T1a+b期的NSLN转移率仅91%、肿瘤T1期且前哨淋巴结数量＞5个的腋窝NSLN转移率仅70%等。单因素分析结果显示,NSLN转移组与NSLN未转移组前哨淋巴结数、肿瘤T分期差异有统计学意义（P<005）。前哨淋巴结2～5个、肿瘤分期为T2～T3期的患者更容易发生腋窝NSLN转移。多因素Logistic回归分析显示,肿瘤分期为T2～T3期、前哨淋巴结数≤5个是患者腋窝NSLN转移的独立危险因素。结论仅有1个前哨淋巴结转移的乳腺癌患者总体腋窝NSLN转移率为224%,肿瘤T分期和前哨淋巴结数为腋窝NSLN转移的影响因素,在对仅1个前哨淋巴结阳性的乳腺癌患者豁免ALND时应重点考虑。     

前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移的影响因素分析

目的 前哨淋巴结活检术(sentinel lymph nodes biopsy,SLNB)已经广泛应用于乳腺癌外科治疗,临床发现部分转移淋巴结仅局限于前哨淋巴结.本研究分析前哨淋巴结(sentinel lymph nodes,SLN)阳性乳腺癌患者非前哨淋巴结(non-sentinel lymph nodes,NSLN)转移的影响因素,从而避免不必要的腋窝淋巴结清除(axillary lymph node dissection,ALND).方法 回顾性分析聊城市人民医院乳腺外科2013-07-1-2015-06-30 SLNB阳性行ALND的77例女性乳腺癌患者临床病理资料,分析NSLN转移的影响因素.结果 在SIN清除个数≥4个的情况下,单因素分析发现阳性SLN≥2个(x2=10.109,P=0.01)以及LuminalB型患者(x2=6.442,P=0.02)发生NSLN转移的风险高.Logistic回归进行多因素分析发现,阳性SLN≥2个是影响NSLN转移的独立危险因素(OR=207.833,95％ CI为1.430～30 201.980,P=0.036).结论 阳性SLN数和分子亚型是影响NSLN转移的危险因素,阳性SLN≥2个是影响NSLN转移的独立危险因素.     

前哨淋巴结阳性早期乳腺癌患者非前哨淋巴结阳性预测因素

摘 要：［目的］ 探讨前哨淋巴结( sentinel lymph node,SLN)阳性早期乳腺癌患者非前哨淋巴结转移的预测因素。［方法］ 回顾性分析2010年7月至2017年8月河南省肿瘤医院578例SLN阳性乳腺癌患者的临床病例资料。通过术中印片及术后连续切片HE染色检测SLN。［结果］ 全组女性非前哨淋巴结阳性率为38.4%。单因素分析显示,阳性SLN数目（χ2=70.114,P=0.001）、阴性SLN数目（χ2=49.095,P<0.001）及Ki67表达水平（χ2=6.924,P=0.009）与非前哨淋巴结转移相关。多因素分析显示,阳性SLN数目(OR=2.076,95％CI：1.686~2.556,P<0.001)、阴性SLN数目(OR=0.673,95％CI：0.586~0.773,P<0.001)和Ki67表达水平(OR=1.807,95％CI：1.150~2.840,P=0.010)是非前哨淋巴结转移的独立预测因素。［结论］ 阳性SLN数目、阴性SLN数目和Ki67表达是乳腺癌非前哨淋巴结转移的独立预测因素。     

治疗前哨淋巴结阳性乳腺癌非前哨淋巴结状态的多因素分析

目的探讨影响前哨淋巴结阳性乳腺癌非前哨淋巴结状态的因素,建立判断有否转移的预测模型。方法回顾性分析我院自2003年-2010年共285例前哨淋巴结阳性乳腺癌患者临床病理资料。采用Logistic回归方法分析13种影响前哨淋巴结阳性乳腺癌非前哨淋巴结状态的因素,建立判断有否转移的预测模型,并验证模型的准确度、敏感度、特异性。结果单因素Logistic回归分析结果提示,有6个因素与NSLN转移具有密切相关性,分别为肿瘤大小（OR=1.45,P<0.01）、阳性SLN大小（OR=2 078.49,P<0.01）、阳性SLN数量(OR=2.44,P<0.01)、阴性SLN数量(OR=0.19,P<0.01)、脉管侵犯(OR=11.45,P<0.01)、阳性SLN包膜外扩散(OR=74.34,P<0.01)。Logistic多因素回归分析表明：肿瘤大小、脉管侵犯、阴性SLN数量、阳性SLN大小及阳性SLN包膜外扩散与NSLN转移密切相关(P<0.05)。Logistic回归模型预测前哨淋巴结阳性乳腺癌非前哨淋巴结状态的敏感度为 92.62%（138/149）,特异性为 89.15%（115/129）,总符合率91.01% (253/278)。结论Logistic回归预测模型能较好的判断前哨淋巴结阳性乳腺癌非前哨淋巴结的状态,[JP2]有助于乳腺肿瘤外科医师选择最佳治疗方案。     

乳腺癌伴1～2枚前哨淋巴结转移腋窝外科处理的研究进展

摘 要：乳腺癌腋窝手术对确立临床分期、辅助治疗选择及预后判断均有重要价值。临床淋巴结阴性的乳腺癌,应用前哨淋巴结活检（SLNB）确定腋窝淋巴结分期已成为标准。对于前哨淋巴结（SLN）阴性的乳腺癌,腋窝淋巴结清扫（ALND）可以避免;而对于SLN阳性的乳腺癌,ALND仍是标准的腋窝处理方式。然而,在SLN阳性患者中进一步行ALND后发现,在仅1～2枚SLN阳性患者中,61.4%～64.5%非前哨淋巴结（nSLN）为阴性。已有大量的临床研究探索了特定条件下的1～2枚SLN阳性患者免除ALND的可行性与安全性。全文就乳腺癌伴1～2枚SLN转移腋窝外科处理的相关研究进行综述。     

前哨淋巴结活检在早期乳腺癌中的应用价值

目的：探讨活性染料亚甲蓝检测早期乳腺癌前哨淋巴结的可行性及其临床意义。方法：利用亚甲蓝对48例乳腺癌患者进行前哨淋巴结活检（SLNB）并同时行腋窝淋巴结清扫（ALND）,根据病理结果进行评价。结果：SLN检出率为95．8％,SLN对ALN状况预测的敏感度为90．3％,准确率为95．7％,假阴性为6．5％,假阳性为0。结论：前哨淋巴结活检能比较准确地反映早期乳腺癌的腋窝淋巴结转移情况,可为SLN阴性的患者“保腋窝”提供依据。     

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.     

Erythropoietin induces lymph node lymphangiogenesis and lymph node tumor metastasis

Cancer therapy often produces anemia, which is treated with erthropoietin (EPO) to stimulate erythrocyte production. However, concerns have recently arisen that EPO treatment may promote later tumor metastasis and mortality. The mechanisms underlying such effects are unknown, but it is clear that EPO has pleiotropic effects in cell types other than hematopoietic cells. In this study, we investigated how EPO affects lymphangiogenesis and lymph node tumor metastasis in mouse models of breast cancer and melanoma. In these models, EPO increased lymph node lymphangiogenesis and lymph node tumor metastasis in a manner associated with increased migration, capillary-like tube formation, and dose- and time-dependent proliferation of human lymphatic endothelial cells. EPO increased sprouting of these cells in a thoracic duct lymphatic ring assay. These effects were abrogated by cotreatment with specific inhibitors of phosphoinositide 3-kinase or mitogen-activated protein kinase, under conditions in which EPO increased Akt and extracellular signal-regulated kinase 1/2 phosphorylation. Intraperitoneal administration of EPO stimulated peritoneal lymphangiogenesis, and systemic treatment of EPO increased infiltration of CD11b(+) macrophages in tumor-draining lymph nodes. Finally, EPO increased VEGF-C expression in lymph node-derived CD11b(+) macrophages as well as in bone marrow-derived macrophages in a dose- and time-dependent manner. Our results establish that EPO exerts a powerful lymphangiogenic function and can drive both lymph node lymphangiogenesis and nodal metastasis in tumor-bearing animals.     

Intramammary lymph nodes

Radiographic, gross, and histopathologic studies on 158 whole breasts with primary operable carcinoma revealed intramammary lymph nodes in 28%, and of these breasts, 10% contained a metastatic deposit of carcinoma. Cancerous and noncancerous nodes were found in all quadrants of the breast with the positive ones being in the same quadrant as the carcinoma only 50% of the time. There was no demonstrable connection with the usual lymphatic drainage of the breast. With Stage II carcinoma, positive intramammary lymph nodes had no direct effect on prognosis, merely representing advanced disease and indicating a greater likelihood of axillary metastatic disease. There was a trend toward poorer prognosis in Stage I lesions with positive intramammary lymph nodes. This may indicate the Stage I carcinomas that have a similar prognosis as Stage II tumors. Conceivably, a Stage Ia, positive intramammary lymph node(s) but normal axillary lymph nodes, could be defined and used.     

Evaluation of lymph node counts in primary retroperitoneal lymph node dissection

BACKGROUND:

Lymph node counts are a measure of quality assurance and are associated with prognosis for numerous malignancies. To date, investigations of lymph node counts in testis cancer are lacking.

METHODS:

By using the Memorial Sloan‐Kettering Testis Cancer database, the authors identified 255 patients who underwent primary retroperitoneal lymph node dissection (RPLND) for nonseminomatous germ cell tumors (NSGCTs) between 1999 and 2008. Features that were associated with lymph node counts, positive lymph nodes, the number of positive lymph nodes, and the risk of positive contralateral lymph nodes were evaluated with regression models.

RESULTS:

The median (interquartile range [IQR]) total lymph node count was 38 lymph nodes (IQR, 27‐53 total lymph nodes), and it was 48 (IQR, 34‐61 total lymph nodes) during the most recent 5 years. Features that were associated with higher lymph node count on multivariate analysis included high‐volume surgeon (P = .034), clinical stage (P = .036), and more recent year of surgery (P < .001); whereas pathologist was not associated significantly with lymph node count (P = .3). Clinical stage (P < .001) and total lymph node count (P = .045) were associated significantly with finding positive lymph nodes on multivariate analysis. The probability of finding positive lymph nodes was 23%, 23%, 31%, and 48% if the total lymph node count was <21, 21 to 40, 41 to 60, and >60, respectively. With a median follow‐up of 3 years, all patients remained alive, and 16 patients developed recurrent disease, although no patients developed recurrent disease in the paracaval, interaortocaval, para‐aortic, or iliac regions.

CONCLUSIONS:

The current results suggested that >40 lymph nodes removed at RPLND improve the diagnostic efficacy of the operation. The authors believe that these results will be useful for future trials comparing RPLNDs, especially when assessing the adequacy of lymph node dissection. Cancer 2010. © 2010 American Cancer Society.     

前哨淋巴结微转移与腋窝淋巴结复发关系的研究进展

乳腺癌是女性最常见的恶性肿瘤，而腋窝淋巴结的转移状态与乳腺癌患者的预后相关。自从开展乳腺癌前哨淋巴结活组织检查以来，一部分乳腺癌患者因前哨淋巴结阴性而免除了腋窝淋巴结清扫，而另一部分患者因前哨淋巴结微转移选择术后放射治疗或是化疗以替代腋窝淋巴结清扫，从而减少了患侧上肢淋巴水肿、运动障碍以及感觉障碍等并发症的发生。近年来，少部分前哨淋巴结微转移患者发生了不同程度的腋窝淋巴结复发。对此，部分学者认为前哨淋巴结微转移患者即使不做腋窝淋巴结清扫，腋窝淋巴结复发率也未见明显增加；但部分学者则认为前哨淋巴结微转移应被视为腋窝淋巴结转移，残留的肿瘤病灶能增加腋窝淋巴结复发率，因此应行腋窝淋巴结清扫术。对于前哨淋巴结微转移的处理方式，国内外专家尚未得出一致的结论。目前众多研究者仍在不懈地进行相关临床试验及大数据分析，旨在为前哨淋巴结微转移患者寻求更佳的治疗方案。     

Groin lymph node detection and sentinel lymph node biopsy in vulvar cancer

ObjectiveTo identify suitable diagnostic tools and evaluate the efficacy of sentinel lymph node (SLN) biopsy for inguinal lymph node metastasis in vulvar cancer.MethodsData from 41 patients with vulvar cancer were evaluated retrospectively, including magnetic resonance imaging (MRI) measurements, SLN biopsy status, groin lymph node metastasis, and prognosis.ResultsSLN biopsy was conducted in 12 patients who had stage I to III disease. Groin lymphadenectomy was omitted in five of the nine patients with negative SLNs. All SLN-negative patients who did not undergo groin lymphadenectomy showed no evidence of disease after treatment. On MRI, the long and short diameters of the inguinal node were significantly longer in metastasis-positive cases, compared with negative cases, in 25 patients whose nodes were evaluated pathologically (long diameter, 12.8 mm vs. 8.8 mm, p=0.025; short diameter, 9.2 mm vs. 6.7 mm, p=0.041). The threshold of >10.0 mm for the long axis gave a sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 70.6%, 58.3%, and 92.3%, respectively, using a binary classification test. Decision tree analysis revealed a sensitivity, specificity, and accuracy of 87.5%, 70.6%, and 76.0%, respectively, with the threshold of >10.0 mm for the long axis on MRI. The criteria of >10.0 mm for the long axis on MRI predicted an advanced stage and poorer prognosis using a validation set of 15 cases (p=0.028).ConclusionMinimally invasive surgery after preoperative evaluation on MRI and SLN biopsy is a feasible strategy for patients with vulvar cancer.     

Superficial lymph node infarction

Suerficial lymph node necrosis is an unusual pathologic diagnosis encountered in clinical practice. When seen it is usually indicative of involvement of the affected lymph nodes with either metastatic cancer or lymphoma. Occasionally it has been associated with hypersensitivity phenomena with arteriolar involvement. The underlying etiology in all of these instances is extensive occlusion of the rich vascular supply to the node. Rarely cases are seen where no clear-cut etiology can be found. Ten such cases have been reported in the medical literature including the case published in this report. Its occurrence, however, may be more common than previously recognized. Preoperatively it is usually not possible to distinguish this entity from the other diagnoses for which it is generally mistaken. These other diagnoses most commonly include femoral hernia and mass in the axillary tail of the breast. The patient reported here is unusual in regard to the size of the lesion encountered. In other published reports very few lymph nodes were involved. In this case extensive involvement of a large mass of nodes was noted. Once the diagnosis is made limited work-up as well as further close observation is important since it may herald the occurrence of a lymphoproliferative disorder.     

Extracapsular lymph node spread

BACKGROUND:

Lymphatic spread is 1 of the most relevant prognostic factors for gastric carcinoma. The current International Union Against Cancer (UICC) pN staging system is based on the number of metastatic lymph nodes and does not take into consideration the characteristics of the metastatic lymph nodes itself. The aim of the current study was to examine the prognostic value of extracapsular lymph node involvement in gastric cancer and to find correlations with clinicopathological parameters.

METHODS:

Tissue samples were obtained from 159 gastric cancer patients who underwent gastrectomy with D2‐lymphadenectomy in 142 (89.3%) cases and subtotal gastrectomy with D2‐lymphadenectomy in 17 (10.7%) cases. The number of resected lymph nodes, number of metastatic lymph nodes, and number of metastatic lymph nodes with extracapsular lymph node involvement were determined. Extracapsular spread was defined as infiltration of cancer cells beyond the capsule of the metastatic lymph node.

RESULTS:

Ninety‐six (60.4%) patients had lymph node metastasis. In 57 (35.8%) cases, extracapsular lymph node involvement was also detected. Extracapsular lymph node involvement was significantly associated with higher pN‐category (P < .001), higher pM category (P = .048), and higher UICC stages (P = .001). According to the Kaplan‐Meier log‐rank statistical method, extracapsular lymph node involvement was significantly associated with poor survival (P = .001). In the multivariate analysis besides pT (P < .001) and R‐category (P = .009), extracapsular lymph node involvement also remained as an independent prognostic factor (P = .003), whereas the UICC pN‐category (P = .822) lost its prognostic value.

CONCLUSIONS:

Extracapsular lymph node involvement is associated with higher tumor stages and is an independent negative prognostic factor in gastric cancer. In future staging systems for gastric cancer, extracapsular lymph node involvement should be considered. Cancer 2010. © 2010 American Cancer Society.