2108例T1~2期乳腺癌患者腋窝淋巴结转移的相关因素分析

目的：探讨T1~2期乳腺癌患者临床与病理因素与腋窝淋巴结转移的关系,指导前哨淋巴结活检术（SL-NB）的应用,以避免腋窝清扫术（ALND）后并发症的发生。方法收集接受手术且经病理确诊的T1~2期乳腺癌病例,对其临床病理资料进行回顾性统计分析。通过单因素分析和多因素Logistic回归分析寻找乳腺癌发生腋窝淋巴结转移的影响因素。结果共2108例患者入组,其中1021例患者发生淋巴结转移（48.4%）。单因素分析显示年龄、肿瘤大小、病理类型、组织学分级、脉管瘤栓、ER、PR、Ki-67指数以及分子分型等因素与淋巴结转移有关（P﹤0.05）;而HER-2是否过表达与淋巴结转移无关。多因素Logistic回归分析显示,患者的腋窝淋巴结转移的独立影响因素为肿瘤大小、病理类型、组织学分级、脉管瘤栓、ER表达状况（P﹤0.05）;而年龄也可能是腋窝淋巴结有无转移的独立影响因素（P=0.053）。结论肿瘤越大、分化越差、伴脉管瘤栓、ER阳性表达以及病理类型为浸润性小叶癌的T1~2期乳腺癌患者的淋巴结转移风险更高,而年龄≤50岁也可能增加了腋窝淋巴结转移的风险。T1~2期乳腺癌患者是否直接行ALND应持谨慎的态度。     

乳腺癌腋窝淋巴结转移的多因素分析

目的:研究乳腺癌腋窝淋巴结转移与年龄、民族、初潮年龄、第一胎生育年龄、绝经、绝经年龄、病程、哺乳时间、妊娠次数、肿瘤部位、肿瘤大小（B超、钼靶、MRI分别测值）、病理分型、雌激素受体（ER）、孕激素受体（PR）、C-erbB-2基因表达之间的关系及规律,为乳腺癌手术中腋窝淋巴结清扫术的指征提供理论依据。方法:回顾性分析356例乳腺癌患者的临床资料。结果:腋窝淋巴结转移228例（64%）,无转移128例（36%）;腋窝淋巴结转移与第一胎生育年龄、妊娠次数、哺乳时间、病程、肿瘤大小(B超、钼靶、MRI)、肿瘤部位、病理类型相关（P<0.05）,P值分别为0.007、0.005、0.006、0.022、（0.001、0.000、0.020）、0.009、0.000。结论:腋窝淋巴结的转移受多种因素影响。     

预测乳腺癌腋窝淋巴结转移的研究进展

19世纪，乳腺癌被认为是局部病变，沿淋巴管转移扩散，且遵循逐级转移即从第一站淋巴结转移到第二站淋巴结，然后再转移到全身的规律。Halsted根治术就是依据这个理论设计的手术方式。直到20世纪60年代Fisher提出乳腺癌是全身性疾病，在病程的早期即可发生全身转移。乳腺癌局部病变的理论便为全身性疾病的理论所替代。并且，依据预后因素用“预后好”或“预后差”的乳腺癌替代“早期”或“晚期”乳腺癌。     

乳腺癌腋窝淋巴结转移规律数学模型的建立

目的：建立一个数学模型，对不完全腋窝淋巴结清扫的患者应用Ⅰ级淋巴结的信息预测Ⅱ、Ⅲ级淋巴结的状态，以指导术后辅助治疗。方法：连续收集９０例女性乳腺癌初治患者行全腋窝淋巴结清扫术的资料，全组共被切出１７９３枚淋巴结，平均每例１９．９２枚；Ⅰ、Ⅱ和Ⅲ级分别为８５６（４７．７４％），６２０（３４．５８％），３１７（１７．６８％）枚，Ⅰ级淋巴结平均为９．５１枚。采用ＳＰＳＳ软件行Ｌｏｇｉｓｔｉｃ多元回归判     

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。     

乳腺癌术后对侧腋窝淋巴结转移7例分析

乳腺癌术后对侧腋窝淋巴结转移７例分析龚益平乳腺癌转移至对侧腋窝淋巴结较为罕见，１９８１作者单位：湖北省肿瘤医院（４３００７９武汉市洪山区卓刀泉南路１６号）年—１９９６年间，我们收治７例，占同期住院乳腺癌病人总数的０．２３％，现报道并分析如下。１临床资...     

乳腺癌腋窝淋巴结转移的超声特征与病理对比分析

淋巴结是好发转移瘤的器官。淋巴结的转移、肿瘤的大小及全身系统的转移是乳腺癌最重要的预后因素,其中,引流区域淋巴结转移的存在与否是最重要的;而且,受侵的淋巴结越多,预后越差。淋巴结清除术、前哨淋巴结活检是目前外科针对早期乳腺癌患者采用的主要手术方式。     

乳腺癌腋窝阳性淋巴结包膜外侵犯的研究现状

腋窝淋巴结是乳腺癌常见的转移部位,腋窝转移淋巴结包膜外侵犯并不少见。迄今为止,乳腺癌淋巴结包膜外侵犯对乳腺癌预后的影响缺乏共识,未纳入乳腺癌分期系统。文章对乳腺癌腋窝阳性淋巴结包膜外侵犯的病理定义、临床意义、影响因素、预后及与腋窝非前哨淋巴结转移的关系等进行了综述。     

乳腺癌腋窝淋巴结转移的MRI评价

乳腺癌是女性最为常见的恶性肿瘤之一,腋窝淋巴结的转移情况对疾病分期、治疗手段的选择以及预后判断具有重要意义。现阶段临床多采用超声或前哨淋巴结活检来评价腋窝淋巴结有无转移,但上述方法存在不足之处或伴随并发症的发生。磁共振成像近年来被越来越多地运用于乳腺癌腋窝淋巴结转移的无创诊断。本文将回顾通过MRI直接评价乳腺癌腋窝淋巴结转移（而非通过肿瘤本身的MRI相关特征预测腋窝淋巴结转移）的文献,并将MRI的相关特征用于诊断乳腺癌腋窝淋巴结转移的准确性进行综述。本文发现目前的研究结果之间存在差异,使用MRI多参数联合可提高诊断准确性,并且影像组学的出现也为诊断带来了新的机遇。     

左侧乳腺癌右腋窝淋巴结转移2例

例1,女,40岁。1994年2月发现左侧乳房有核桃大小肿块,不红不痛,无发热,边界不清。4月20日住院治疗,查体:左乳头抬高,无溢液,皮肤无改变。乳房内上限触及5cm×5cm肿块,质中,界限不清,与胸大肌无粘连。左腋窝触及肿大淋巴结2枚。右乳房及液窝淋巴结无异常。X光片示肺部正常。诊断:左侧乳腺癌(Ⅲ期)。行改良式乳癌根治术。     

早期乳腺癌腋淋巴结转移的多因素分析

目的：探讨早期乳腺癌腋淋巴结转移（ALNM）的相关因素,并对阴性腋淋巴结行角蛋白19（CK19）检测以发现微转移癌.方法：收集乳腺癌病例138例,建立数据库,用Logistic回归进行单因素和多因素分析,并对有意义的指标进行相关分析,对40例患者441枚阴性腋淋巴结再切片,用CK19行免疫组织化学染色.结果：多因素分析显示肿瘤大小、肿瘤部位、癌抗原153（CA153）、人类表皮生长因子受体-2（HER2）4个指标进入Logistic回归方程,40例患者中有3例患者的腋窝淋巴结CK19免疫组织化学染色阳性.结论：肿瘤大小、肿瘤部位、CA153和HER2为乳腺癌患者ALNM的高危因素;CK19免疫组织化学染色可发现乳腺癌腋淋巴结微转移癌.     

Sentinel node biopsy to avoid axillary lymph node dissection in breast cancer

The role of sentinel node biopsy in breast cancer has increased over the last few years. Sentinel nodes can predict the status of all axillary lymph nodes precisely and select patients with negative nodes for whom axillary dissection is unnecessary. Many problems remain, such as the ideal injection technique, ideal agents, and ideal histological detection of sentinel node metastases, and must be addressed before sentinel node biopsy becomes the standard of care for patients with breast cancer.     

Sentinel node biopsy in breast cancer

Axillary lymphnode dissection (ALND) for breast cancer patients provides local control and information for the determination of the type of adjuvant therapy. The benefit of axillary surgery itself for survival is considered to be limited to patients with positive nodes. Sentinel node biopsy is a recently developed, minimally invasive technique for precisely predicting axillary nodal status. As this technique has less morbidity and greater accuracy than ALND, it replaces ALND for patients with node negative breast cancer. In this report, we outline the current status of sentinel node biopsy for breast cancer patients and introduce our preliminary results.     

The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population

Objective To assess whether the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram for prediction of NSLN metastasis is useful in a German breast cancer population and whether the characteristics of the breast tumor and the sentinel lymph node (SLN) are able to predict the likelihood of non-sentinel lymph node (NSLN) metastasis. Methods A total of 545 patients with primary breast cancer and SLN examination were evaluated. The MSKCC nomogram was applied to 98 patients with a positive SLN who subsequently had completion axillary lymph node dissection (ALND). Predictive accuracy was assessed by calculating the area under the receiver-operator characteristic (ROC) curve. The collective was evaluated by correlating the prevalence of NSLN and SLN metastasis to pathological features. Results The MSKCC nomogram achieved a ROC of 0.58 indicating a bad accuracy of the nomogram. Tumor size, histology, lymphovascular infiltration, multifocality, Her-2-neu positivity, and nuclear grade correlated with the probability of SLN metastasis. Histology and primary tumor localization correlated significantly with the probability of NSLN metastasis. Conclusions The MSKCC nomogram did not provide a reliable predictive model in our study population. However, the likelihood of SLN metastasis correlated with the presumed risk factors and no obvious differences between the MSKCC population and our population could be seen. In order to achieve interinstitutional reproducibility, standardization of surgical procedure and of the pathological assessment of the SLN is desirable.     

乳腺癌腋窝淋巴结声像图联合免疫组织化学与淋巴结转移的相关性研究

背景与目的：乳腺癌腋窝淋巴结转移对于乳腺癌患者的预后及治疗方案的选择有重要的指导意义。本研究旨在探讨乳腺癌腋窝淋巴结声像图表现联合免疫组织化学与腋窝淋巴结转移的相关性。方法：回顾性分析应用超声检出的366例乳腺癌患者共计728枚腋窝淋巴结的声像图表现,采用单因素分析、多因素logistic回归及受试者工作特征(receiver operating characteristic,ROC)曲线分析的方法,分别检验乳腺癌腋窝淋巴结皮质最大厚度、长短径之比、皮髓质之比和淋巴结血流特征,联合乳腺癌术后免疫组织化学结果,研究其与病理学腋窝淋巴结转移的相关性。结果：依据单因素分析,腋窝淋巴结皮质最大厚度、长短径之比、血流特征以及乳腺癌病灶p53的阳性表达率与淋巴结转移有关(P<0.05)。依据多因素分析及ROC分析,腋窝淋巴结皮质最大厚度是判定腋窝淋巴结转移的最佳指标。腋窝淋巴结皮质最大厚度大于3 mm的患者,其乳腺癌病灶的p53阳性表达率(42.78%)明显高于皮质最大厚度小于等于3 mm的患者(25.82%),差异有统计学意义(P<0.01)。结论：乳腺癌腋窝淋巴结声像图表现联合免疫组织化学评价腋窝淋巴结转移,对乳腺癌的临床诊疗方法选择具有重要价值。     

Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer

Aims

Currently, it is standard practice to avoid ALND in patients with negative SLN, whereas this procedure is mandated for those with positive SLN. However, there has been some debate regarding the necessity of complete ALND in all patients with positive SLN. This review article discusses the issues related to eliminating the need for ALND in selected patients with positive nodes.

Methods

A review of the English language medical literature was performed using the MEDLINE database and cross-referencing major articles on the subject, focusing on the last 10 years.

Results

Currently, complete ALND is mandated in patients with SLN macrometastases as well as those with clinically positive nodes. It is not clear whether SLN biopsy is appropriate for axillary staging in patients with initially clinically positive nodes (N1) that become clinically node-negative (N0) after neoadjuvant chemotherapy. Although there is debate regarding whether ALND should be performed in patients with micrometastases in the SLN, it seems premature to abandon ALND in clinical practice. Moreover, it remains unclear whether it is appropriate to avoid complete ALND in patients with ITC-positive SLN alone.

Conclusions

In the absence of data from randomised trials, the long-term impact of SLN biopsy alone on axillary recurrence and survival rate in patients with SLN micrometastases as well as those with ITC-positive SLN remains uncertain. These important issues must be determined by careful analysis of the results of ongoing clinical trials.     

Controversies in sentinel node biopsy for breast cancer

Sentinel node biopsy for breast cancer patients has recently been applied as a less invasive, highly accurate alternative to axillary lymph node dissection. Numerous studies have shown that sentinel nodes accurately diagnose axillary staging. However, many problems remain to be answered and must be addressed before sentinel node biopsy becomes the standard surgical procedure for patients with breast cancer. We reviewed and discussed here three of these problems; axillary sampling as an alternative to sentinel node biopsy, dye method vs. combination of dye and radiocolloid for sentinel node biopsy, and intraoperative sentinel node examination. Further investigation will continue to be necessary as we learn how to better provide procedure of sentinel node biopsy.     

Sentinel lymph node biopsy in breast cancer: an overview of the Japanese experience

This paper reviews the Japanese literature regarding sentinel lymph node (SLN) biopsy in an attempt to provide an overview of existing controversies and to suggest a method for the identification of the SLN and the detection of micrometastases in the SLN to eliminate unnecessary axillary lymph node dissection (ALND). The combined dye- and gamma probe-guided method resulted in the accurate identification of the SLN in 96% of patients, compared with 80% when the dye-guided method alone was used. Although neither 99m-Tc sulfur colloid nor 99m-Tc colloidal albumin is commercially available in Japan, 99m-Tc stannous phytate and 99m-Tc rhenium colloid appear to be ideal tracers for identifying SLNs. Moreover, subdermal injection over the primary tumor or subareolar injection was found to enhance SLN identification, although these injection routes do not lead to detection of internal mammary SLNs. Furthermore, the accuracy of SLN diagnosis using frozen sections as well as imprint cytology improved with an increase in the number of sections, and could attain a sensitivity comparable to that obtained with routine histologic examination of permanent sections. As a result, several surgeons have begun to offer the option of forgoing ALND to patients with negative SLN. Although subsequent relapse in the axilla has not yet been reported, longer follow-up periods are needed to assess accurately the incidence of axillary failure in these negative SLN patients.     

Predicting axillary lymph node metastases in breast cancer patients with tumors under 2 cm in size

Background  To assess whether lymph nodes are consistently negative below a certain tumor size, we investigated the incidence and predictors of lymph node metastasis in breast cancer patients with tumors under 2 cm in size. Methods  A total of 238 breast cancer patients with tumors under 2 cm in size were retrospectively reviewed. Results  Preoperatively, 219 tumors were palpable while 19 were not. There was no lymph node metastasis in the nonpalpable tumors (n=19) or those 5 mm or less in size (n=1) tumors, but 17% of those greater than 5 mm but less than 10 mm (n=30) and 29% of those greater than 10 mm but 20 mm or less (n=188) tumors had nodal involvement. Conclusions  Our sample size was too small to determine a specific tumor size that would warrant omission of axillary lymph node dissection. However, axillary lymph node dissection may be avoided in breast cancer patients with clinically nonpalpable tumors.     

Clinical impact of false-negative sentinel lymph nodes in breast cancer

Aims

To evaluate the incidence of false-negative (FN) sentinel lymph node (SLN) cases, their correlation with a series of clinico-pathologic parameters and their impact on adjuvant treatment indications and on clinical axillary relapse in the setting of a multicentric clinical trial comparing SLN biopsy with axillary lymph node dissection (ALND).

Methods

A series of 697 patients with primary breast cancer ≤ 3 cm were randomized to SLN biopsy associated with ALND (ALND arm) or to SLN biopsy followed by ALND only if the SLN was metastatic (SLN arm). The FN SLN rate was assessed in the ALND arm. A series of 11 clinico-pathological parameters were tested for a possible association with FN results. The indications for adjuvant treatments were evaluated by considering both the FN nodal stages, as indicated by the SLN, and the true positive axillary status, as indicated by completion ALND. The occurrence of clinically evident axillary recurrences was evaluated in the two arms.

Results

The FN rate was 16.7%. Of the clinico-pathologic parameters tested, only a tumour size ≤ 2 cm and the presence of a single metastatic axillary node was significantly associated with a risk of FN (p = 0.033 and p = 0.018, respectively). The FN SLN would have led to different adjuvant therapy indications in 12/18 cases. At 56 months, no clinically evident axillary nodal recurrences were present in the ALND arm patients, whereas one case of axillary recurrence was detected in the SLN arm patients.

Conclusions

FN SLN biopsy is not uncommon, especially in the presence of a small primary tumour with a single nodal metastasis. An FN finding can lead to less than optimal adjuvant treatment. However, the clinical impact of FN in terms of axillary recurrence at 56 months was minimal.