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1.
van Rijk MC Nieweg OE Rutgers EJ Oldenburg HS Olmos RV Hoefnagel CA Kroon BB 《Annals of surgical oncology》2006,13(4):475-479
Background Neoadjuvant chemotherapy in breast cancer patients is a valuable method to determine the efficacy of chemotherapy and potentially
downsize the primary tumor, which facilitates breast-conserving therapy. In 18 studies published about sentinel node biopsy
after neoadjuvant chemotherapy, the sentinel node was identified in on average 89%, and the false-negative rate was on average
10%. Because of these mediocre results, no author dares to omit axillary clearance just yet. In our institute, sentinel lymph
node biopsy is performed before neoadjuvant chemotherapy. The aim of this study was to evaluate our experience with this approach.
Methods Sentinel node biopsy was performed before neoadjuvant chemotherapy in 25 T2N0 patients by using lymphoscintigraphy, a gamma
ray detection probe, and patent blue dye. Axillary lymph node dissection was performed after chemotherapy if the sentinel
node contained metastases.
Results Ten patients had a tumor-positive axillary sentinel node, and one patient had an involved lateral intramammary node. Four
patients had additional involved nodes in the completion lymph node dissection specimen. The other 14 patients (56%) had a
tumor-negative sentinel node and did not undergo axillary lymph node dissection. No recurrences have been observed after a
median follow-up of 18 months.
Conclusions Fourteen (56%) of the 25 patients were spared axillary lymph node dissection when the sentinel node was found to be disease
free. Performing sentinel node biopsy before neoadjuvant chemotherapy seems successful and reliable in patients with T2N0
breast cancer. 相似文献
2.
Kühn T 《Breast care (Basel, Switzerland)》2011,6(3):185-191
The role of axillary surgery for the treatment of primary breast cancer is in a process of constant change. During the last decade, axillary dissection with removal of at least 10 lymph nodes (ALD) was replaced by sentinel lymph node biopsy (SLNB) as a staging procedure. Since then, the indication for SLNB rapidly expanded. Today's surgical strategies aim to minimize the rate of patients with a negative axillary status who undergo ALD. For some subgroups of patients, the indication for SLNB (e.g. multicentric disease, large tumors) or its implication for treatment planning (micrometastatic involvement, neoadjuvant chemotherapy) is being discussed. Although the indication for ALD is almost entirely restricted to patients with positive axillary lymph nodes today, the therapeutic effect of completion ALD is more and more questioned. On the other hand, the diagnostic value of ALD in node-positive patients is discussed. This article reflects today's standards in axillary surgery and discusses open issues on the diagnostic and therapeutic role of SLNB and ALD in the treatment of early breast cancer. 相似文献
3.
乳腺癌前哨淋巴结活检的研究进展 总被引:4,自引:0,他引:4
目的 报道乳腺癌前哨淋巴结活检的研究进展。方法 采用文献回顾的方法,对国外乳腺癌前哨淋巴结活检的历史、概念、活检技术以及临床应用等问题进行综述。结果 乳腺癌前哨淋巴结活检的操作方法还没有统一的标准,检出率及假阴性率变化范围广。结论 前哨淋巴结活检的临床应用还需要大量前瞻性多中心随机实验结果进一步论证。 相似文献
4.
目的总结乳腺癌前哨淋巴结活检(SLNB)的研究现状和进展。方法复习近年来国内外的相关文献,对乳腺癌SLNB的概念、适应证、活检技术、提高检出准确率的方法、病理学检查方法、转移灶类型、临床应用等进行综述。结果 SLNB的适应证在不断扩大。示踪剂、影像学检查和病理学检查技术的发展有助于对乳腺癌前哨淋巴结(SLN)状态的评估。乳腺癌SLNB的操作方法还没有统一的标准,对其能否指导选择性的腋窝淋巴结清扫的争议较大,且SLNB的SLN检出率及假阴性率变化范围较大。结论 SLNB已成为乳腺癌外科治疗的重要辅助手段,但其操作尚需进一步规范,其临床应用范围还需要大量前瞻性、多中心的随机试验进一步论证。 相似文献
5.
Leidenius MH Krogerus LA Toivonen TS Leppänen EA von Smitten KA 《Annals of surgical oncology》2006,13(3):321-326
Background Lymphoscintigraphy (LS) with sentinel node (SN) biopsy is proposed to provide a feasible method to complete lymphatic staging
in breast cancer. The aim of this study was to evaluate the clinical value of parasternal SN biopsy.
Methods A total of 984 consecutive patients with clinical stage T1/2N0 invasive breast cancer who underwent LS and SN biopsy were
included in the study. A prospectively collected database was used. An intratumoral injection of 50 to 145 MBq of 99mTc-labeled human albumin colloid (Nanocoll) was used for preoperative LS.
Results LS showed the axillary SN in 844 (86%) cases and the parasternal SN in 138 (14%) cases. The median number of visualized parasternal
SN was 2 (range, 1–6). Visualization of the parasternal SN was more common in patients with mediocentral tumors (81 of 399;
20%) and in patients with lateral tumors (56 of 585; 10%; P < .0001). Parasternal SNs were visualized more often, in 100 (17%) of 584 patients without axillary metastases compared with
38 (10%) of 400 patients with metastatic axillary nodes (P = .0006). Parasternal SNs were harvested successfully in 121 (88%) patients with visualization of those nodes. Parasternal
SN metastases were detected in 18 patients, with a median of 1 metastasis (range, 1–4 metastases). Eight of these 18 patients
were axillary node negative.
Conclusions Parasternal SN biopsy results in upstaging in 2% of all breast cancer patients who undergo SN biopsy. The clinical value of
the procedure seems insignificant, although it may influence the adjuvant treatment regimen in some patients. 相似文献
6.
Ultrasonography and Fine-Needle Aspiration Cytology Can Spare Breast Cancer Patients Unnecessary Sentinel Lymph Node Biopsy 总被引:2,自引:0,他引:2
van Rijk MC Deurloo EE Nieweg OE Gilhuijs KG Peterse JL Rutgers EJ Kröger R Kroon BB 《Annals of surgical oncology》2006,13(1):31-35
Background Some 30% to 40% of the breast cancer patients scheduled for sentinel node biopsy have axillary metastasis. Pilot studies suggest
that ultrasonography is useful in the preoperative detection of such nodes. The aims of this study were to evaluate the sensitivity
of preoperative ultrasonography and fine-needle aspiration cytology for detecting axillary metastases and to assess how often
sentinel node biopsy could be avoided.
Methods Between October 1999 and December 2003, 726 patients with clinically negative lymph nodes were eligible for sentinel node
biopsy. A total of 732 axillae were examined. Preoperative ultrasonography with subsequent fine-needle aspiration cytology
in case of suspicious lymph nodes was performed in all patients. The sentinel node procedure was omitted in patients with
tumor-positive axillary lymph nodes in lieu of axillary lymph node dissection.
Results Ultrasound and fine-needle aspiration cytology established axillary metastases in 58 (8%) of the 726 patients. These 58 were
21% of the total of 271 patients who were proven to have axillary metastasis in the end. Of the patients with ultrasonographically
suspicious lymph nodes and negative cytology, 31% had tumor-positive sentinel nodes. Patients with preoperatively established
metastases by ultrasonography and fine-needle aspiration cytology had more tumor-positive lymph nodes (P < .001) than patients with metastases established later on.
Conclusions The sensitivity of ultrasonography and fine-needle aspiration cytology is 21%, and unnecessary sentinel node biopsy is avoided
in 8% of the patients. This approach improves the selection of patients eligible for sentinel node biopsy. 相似文献
7.
van der Ploeg IM Kroon BB Antonini N Valdés Olmos RA Rutgers EJ Nieweg OE 《Annals of surgical oncology》2008,15(4):1025-1031
Background At our institution, tracer fluids are administered in the primary breast cancer and, in addition to the ones in the axilla,
sentinel nodes outside the axilla are rigorously pursued. The objective of the present study of sentinel node-negative breast
cancer patients was to determine the lymph node recurrence rates in the axilla and elsewhere, the false-negative rates, and
the survival.
Methods Between January 1999 and November 2005, 1,019 breast cancer patients underwent a sentinel node biopsy. In 748 of them, 755
sentinel node biopsies did not reveal a tumor-positive sentinel node and they did not undergo axillary node dissection. Metastases
were revealed in 284 sentinel node biopsies performed in the remaining 271 patients: 247 in the axilla, 20 outside the axilla,
and 17 both in the axilla and elsewhere. The median follow-up duration was 46 months.
Results Two of the 748 sentinel node-negative patients developed an axillary lymph node recurrence (0.25%) and two others developed
a supraclavicular lymph node recurrence (0.25%). The overall lymph node recurrence rate was 0.5%. The false-negative rates
were 1.4% overall, 0.8% for the axilla, and 5.1% for the extra-axillary nodes. After five years, 95.9% of all sentinel node-negative
patients were alive and 89.7% were alive without evidence of disease.
Conclusion The low recurrence and false-negative rates and promising survival figures show that our lymphatic mapping method with intralesional
tracer administration is accurate for the axilla. Outside the axilla, 5.1% of involved sentinel nodes were missed. 相似文献
8.
目的探讨乳腺癌前哨淋巴结活检(SLNB)技术的研究现状和进展。方法复习近年来国内、外的有关文献,对乳腺癌SLNB的定位、检取、状态评估、适应证和并发症进行分析与综述。结果乳腺癌SLNB能够准确定位、检取前哨淋巴结(SLN)。影像学检查和病理检测技术的发展有助于SLN状态的评估,SLNB的适应证正在不断扩大。该技术并发症少,能够准确判定腋窝分期,指导选择性的腋窝淋巴结清扫。结论 SLNB技术已成为乳腺癌外科治疗的重要手段,但其操作尚需进一步规范,以降低假阴性的发生;假阳性和有争议的适应证问题仍需继续关注。 相似文献
9.
Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma 总被引:1,自引:0,他引:1
Jeffrey D. Wagner MD Darrell Davidson MD PhD John J. Coleman III MD Gary Hutchins PhD Donald Schauwecker MD PhD Hee-Myung Park MD Robert J. Havlik MD 《Annals of surgical oncology》1999,6(4):398-404
Background: Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics.Methods: Review of a consecutive series of patients with clinically localized cutaneous melanoma who underwent SNB of nonpalpable regional lymph node basins followed by complete lymphadenectomy (LND) was performed. Multiple lymph node sections from positive SNs and nonsentinel nodes (NSNs) in LND specimens were examined microscopically. Individual tumor deposit diameters were measured using an ocular micrometer. Aggregate tumor volumes were calculated for SN and LND specimens. Tumor volumes and SN and LND positivity rates were correlated with tumor thickness, the number of positive SNs, and the presence of multiple SN tumor deposits.Results: SNB procedures were performed for 149 melanomas in 189 regional nodal basins. The mean tumor depth was 2.48 mm. The mean number of SNs/basin was 2.1. Thirty-two of 149 SNB procedures (21.5%) revealed a total of 34 nodal basins with at least one positive SN. The median tumor volume in positive SNs was 4.7 mm3 (range, 0.1-3618 mm3; mean, 209 mm3). The median aggregate tumor volume in positive LND specimens was 4.9 mm3 (range, 0.1-3618 mm3; mean, 224 mm3). Six basins (17.6%) contained at least one positive NSN. The regional node aggregate tumor volume correlated weakly with tumor thickness (Pearsons correlation coefficient = .302, P = .0934). NSN positivity was not predicted by tumor thickness, American Joint Committee on Cancer tumor stage, number of positive SNs, or number of metastatic deposits within SNs.Conclusions: Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs. 相似文献
10.
Badgwell BD Povoski SP Abdessalam SF Young DC Farrar WB Walker MJ Yee LD Zervos EE Carson WE Burak WE 《Annals of surgical oncology》2003,10(4):376-380
Background: Sentinel lymph node biopsy (SLNB) is gaining acceptance as an alternative to axillary lymph node dissection. The purpose of this study was to determine the frequency and pattern of disease recurrence after SLNB.Methods: Two-hundred twenty-two consecutive patients undergoing SLNB from April 6, 1998, to October 27, 1999, and who were 24 months out from their procedure were identified from a prospectively maintained database. Retrospective chart review and data analysis were performed to identify variables predictive of recurrence.Results: The median patient follow-up was 32 months (range, 24–43 months). A total of 159 patients (72%) were sentinel lymph node (SLN) negative and had no further axillary treatment. Five of these patients (3.1%) developed a recurrence (one local and four distant), with no isolated regional (axillary) recurrences. Sixty-three patients (28%) were SLN positive and underwent a subsequent axillary lymph node dissection. Six of these patients (9.5%) developed a recurrence (three local, one regional, and two distant). Pathologic tumor size (P < .001), lymphovascular invasion (P = .018), and a positive SLN (P = .048) were all statistically significantly associated with disease recurrence.Conclusions:With a minimum follow-up of 24 months, patients with a negative SLN and no subsequent axillary treatment demonstrate a low frequency of disease recurrence. This supports the use of SLNB as the sole axillary staging procedure in SLN-negative patients. 相似文献
11.
Altomare V Guerriero G Carino R Battista C Primavera A Altomare A Vaccaro D Esposito A Ferri AM Rabitti C 《Surgery today》2007,37(9):735-739
Purpose For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel
lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the
axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC)
to identify metastatic axillary lymph nodes in the pre-operative phase.
Methods One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1–2 cN0) underwent
echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive
value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node
biopsy or an axillary lymphadenectomy as a reference standard.
Results It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV
100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures
of presurgical staging.
Conclusion This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph
node biopsy while also sparing the patient the stress of undergoing a second surgery. 相似文献
12.
Taback B Nguyen P Hansen N Edwards GK Conway K Giuliano AE 《Annals of surgical oncology》2006,13(8):1099-1104
Background Lymphatic mapping (LM) with sentinel lymph node (SLN) biopsy has revolutionized the surgical staging of primary breast cancer,
but its utility and feasibility have not been established in patients with ipsilateral breast tumor recurrence (IBTR) after
breast-conserving surgery (BCS) and radiation.
Methods We reviewed our breast cancer database to identify all patients who underwent preoperative lymphoscintigraphy for IBTR and
whose primary tumor had been managed by BCS, SLN biopsy and/or axillary node dissection, and adjuvant breast irradiation.
Results Preoperative lymphoscintigraphy identified migration to the regional nodal drainage basins in 11 (73%) of 15 patients, as
follows: 5 ipsilateral axillary, 1 supraclavicular, 2 internal mammary, 2 interpectoral, and 3 contralateral axillary. Two
patients demonstrated drainage to two nodal basins. In four patients, no drainage was observed. Intraoperative LM with radioisotope
plus blue dye identified at least 1 SLN in 11 of 14 patients, and histopathologic evaluation revealed metastasis in 3 patients
(2 contralateral axillary and 1 ipsilateral axillary). During preoperative lymphoscintigraphy, the radiocolloid migration
time tended to be longer and the drainage pathways more variable than those associated with primary tumors.
Conclusions LM/SLN biopsy can be successfully performed in patients with IBTR after prior BCS, axillary surgical staging, and adjuvant
radiation. This approach illustrates variations in the lymphatic drainage of recurrent breast tumors and may permit the identification
of regional metastasis not noted with conventional imaging techniques. 相似文献
13.
Subareolar Injection May Be More Accurate Than Other Techniques for Sentinel Lymph Node Biopsy in Breast Cancer 总被引:2,自引:1,他引:1
D'Eredita' G Ferrarese F Cecere V Massa ST de Carne F Fabiano G 《Annals of surgical oncology》2003,10(8):942-947
Background: The aims of this study were to compare peritumoral injection of 99mTc-labeled albumin and subdermal injection of blue dye with subareolar (SA) injection of blue dye alone in terms of success of the sentinel lymph node identification rate, false negative (FN) rate, overall accuracy, and sensitivity of the two procedures.Methods: From January 1999 to October 2002, 155 patients with localized breast cancer were treated. Patients were subdivided into two groups. In patients in group 1 (n = 115; January 1999 to December 2001), lymphoscintigraphy together with injection of vital dye was performed. In patients in group 2 (n = 40; January 2002 to October 2002), SA injection of blue dye alone was performed.Results: In patients in group 1, the overall successful identification rate was 94.8%. The success rate of identifying a sentinel lymph node by a combination of the two techniques was 95%. With blue dye alone, the successful identification rate was 94.6% in patients in group 1 (subdermal) and 97.5% in group 2 (SA). The FN rate was 9% in group 1 and 0% in group 2. The overall accuracy of lymphatic mapping was 97% in group 1 and 100% in group 2. Sensitivity was 91% in group 1 and 100% in group 2.Conclusions: This study of dye-only injection into the SA plexus demonstrates a high sentinel node identification rate, absent FN rate, and rapid learning curve. On the basis of these findings, we propose that injections into the SA lymphatic plexus are the optimal way to perform dye-only lymphatic mapping of the breast. 相似文献
14.
Baron RH Fey JV Borgen PI Stempel MM Hardick KR Van Zee KJ 《Annals of surgical oncology》2007,14(5):1653-1661
Background The aim of this study is to evaluate prevalence, severity, and level of distress of 18 sensations at baseline (3–15 days)
and 5 years after breast cancer surgery, and compare sensations after sentinel lymph node biopsy (SLNB) with those after SLNB
plus immediate or delayed axillary lymph node dissection (ALND).
Methods A total of 187 patients with breast cancer completed the Breast Sensation Assessment Scale at baseline and at 3, 6, 12, 24,
and 60 months after surgery to assess prevalence, severity, and level of distress of sensations. Of these, 133 had SLNB, and
54 had SLNB and ALND. Additionally, of the 187 patients, 141 had breast-conservation therapy and 46 had total mastectomy.
Results Sensations were less prevalent, severe, and distressing after SLNB compared with ALND at baseline and at 5 years. This difference
was most evident in those who had breast-conservation therapy. Most sensations after SLNB and ALND, even if prevalent, were
not severe or distressing. Some sensations remained notably prevalent at 5 years, including tenderness and twinges after SLNB,
and tightness and numbness after ALND. Phantom sensations were frequently reported by mastectomy patients.
Conclusions Prevalence, severity, and level of distress of sensations were lower after SLNB compared with ALND, but some morbidity existed
after SLNB. Certain sensations remained highly prevalent in both groups for up to 5 years. 相似文献
15.
临床腋淋巴结阴性乳腺癌前哨淋巴结研究 总被引:21,自引:2,他引:21
目的:探讨前哨淋巴结活检术(sentinel lymph node biopsy, SLNB)在乳腺癌治疗中的应用。方法:使用专利蓝和美蓝染色,对1999年9月~2001年4月连续收治的145例临床查体腋窝淋巴结阴性乳腺癌病人行前哨淋巴结活检术。结果:SLNB成功率为96.5%(140/145),假阴性率为23.5%,准确率为91.4%。病人年龄、肿瘤最大径、肿瘤部位、注射染料类型及是否活检对成功率和假阴性率无影响。结论:SLNB能够准确预测腋窝淋巴结的转移状况,在缩小手术范围、减少术后并发症的同时,提高了腋窝淋巴结分期的准确性;美蓝与专利蓝均可成功确定SLN。 相似文献
16.
Idam de Oliveira-Junior Eliana Aguiar Petri Nahas Ana Cristina Cherem Jorge Nahas-Neto Ren Aloisio da Costa Vieira 《Breast care (Basel, Switzerland)》2021,16(1):27
IntroductionBreast cancer represents the most common type of cancer among women in the world. The presence and extent of axillary lymph node involvement represent an important prognostic factor. Sentinel lymph node biopsy (SLNB) is currently accepted for T1 and T2 with negative axillae (N0); however, many patients with T3-T4b tumors with N0 are often submitted to unnecessarily axillary lymph node dissection.Materials and MethodsThis is a retrospective, observational study of patients treated for breast cancer between 2008 and 2015, with T3/T4b tumors and N0, who underwent SLNB. A systematic review of the literature was also carried out in 5 bases.ResultsWe analyzed 73 patients, and SLNB was negative for macrometastasis in 60.3% of the cases. With a mean follow-up of 45 months, no ipsilateral axillary local recurrence was observed. In the systematic review, only 7 articles presented data for analysis. Grouping these studies with the present series, the rate of N0 was 32.1% for T3 and 61.0% for T4b; grouping all studies (T3 and T4b n = 431) the rate was 32.5%.ConclusionsSLNB in T3/T4b tumors is a feasible and safe procedure from the oncological point of view, as it has not been associated with ipsilateral axillary relapse. 相似文献
17.
Cox C White L Allred N Meyers M Dickson D Dupont E Cantor A Ly Q Dessureault S King J Nicosia S Vrcel V Diaz N 《Annals of surgical oncology》2006,13(5):708-711
Background Sentinel lymph node (SLN) biopsy combined with microstaging-associated immunohistochemical staining for cytokeratin more accurately
assigns patients to their corresponding diagnostic stage. The purpose of this study was to compare the survival outcomes of
node-negative patients who received an SLN biopsy with historical control data of node-negative patients who received routine
complete axillary lymph node dissection (CALND) in the pre-SLN biopsy era.
Methods Under institutional review board approval, 2458 node-negative invasive breast cancer patients between the ages of 25 and 94
years (mean, 60 years) were treated at our institution from January 1986 to May 2004. Of these 2458 patients, 604 (25%) were
evaluated with CALND, whereas 1854 (75%) were evaluated with SLN biopsy. All were treated according to the current stage-specific
guidelines. Kaplan-Meier graphs of overall survival and disease-free survival were constructed for each group of patients,
and the two groups were compared by using the log-rank test.
Results Overall survival and disease-free survival for the CALND and SLN biopsy groups did not differ significantly (P = .98). The average number of lymph nodes extracted in the pre-SLN biopsy group was 18, whereas the average number of SLNs
extracted in the post-SLN biopsy group was 3.
Conclusions The survival rate among node-negative breast cancer patients who received an SLN biopsy alone has proven to have no significant
difference (P = .98) from the survival rate among node-negative patients who received a CALND. SLN biopsy alone should replace CALND as
the primary tool for axillary staging of breast cancer in node-negative patients. 相似文献
18.
Background Patients with sentinel lymph node (SLN) metastases need delayed completion axillary lymph node dissection (ALND) if intraoperative
assessment of SLN is not employed. This study was designed to compare morbidity in patients undergoing complete ALND in the
first (and only) operation versus those undergoing the two-step procedure (SLN biopsy followed by delayed completion ALND).
Methods Secondary analysis of the Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) randomized trial compared
83 patients with SLN metastases who proceeded to delayed completion ALND (two-step ALND) with 96 node-positive patients who
underwent ALND as the only axillary procedure (one-step ALND). Outcome variables were assessed at baseline and at 3, 6, and
12 months after surgery.
Results The 83 SLN-positive patients undergoing completion ALND were younger (p = 0.038) compared with the one-step ALND group. There was no difference in lymphedema, sensory loss, intercostobrachial (ICB)
nerve division rates, impairment of shoulder movement, infection rate, or time to resumption of normal day-to-day activities
after surgery between the two groups. Median axillary operative time for completion ALND in the two-step group was significantly
higher than one-step ALND (33 min vs. 25 min, p = 0.004). The median hospital stay for the second surgery in the two-step group was similar to one-step ALND (6 days). The
total median hospital stay (first and second surgery) was significantly higher for the two-stage procedure (10 vs. 6 days,
p < 0.001).
Conclusion A two-stage axillary node dissection procedure in patients with SLN metastases has similar arm morbidity to one-stage ALND.
The second surgery is associated with increased axillary operative time and total hospital stay. 相似文献
19.
Background In this study we performed subdermal injection of 99mTc-labeled albumin combined with subareolar (SA) injection of blue dye, and we compared this technique with two techniques
previously used in terms of the success of sentinel lymph node (SLN) identification, false-negative (FN) rate, and the overall
accuracy and sensitivity of the three procedures. In all patients we performed a complete axillary lymph node dissection.
Methods From January 1999 to September 2004, a total of 195 patients with localized breast cancer were treated. Patients were subdivided
into three groups. In patients in group 1 (n = 115; January 1999 to December 2001), lymphoscintigraphy together with injection
of vital dye was performed; in group 2 (n = 40; January to October 2002), SA injection of blue dye alone was performed; and
in group 3 (n = 40; November 2002 to September 2004), SA injection of blue dye and subdermal injection of radioisotope was
performed.
Results The success rate of identifying an SLN by a combination of the two techniques was 95% in group 1 and 100% in group 3. The
FN rate was 9% in group 1 and 0% in groups 2 and 3. The overall accuracy of lymphatic mapping was 97% in group 1 and 100%
in groups 2 and 3. Sensitivity was 91% in group 1 and 100% in groups 2 and 3.
Conclusions This study of SA injection for SLN biopsy using dual tracers demonstrates a high SLN identification rate and an absent FN
rate. We propose that injection into the SA plexus is the optimal way to perform lymphatic mapping of the breast. This technique
seems to be feasible even in patients with multicentric cancers. 相似文献