腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响

目的探究腋窝淋巴结状态对乳腺癌保乳手术后复发病人的预后影响。方法选取2012年4月～2015年5月南京市妇幼保健院收治的476例行乳腺癌保乳手术后复发的乳腺癌病人作为研究对象。根据做乳腺癌保乳手术时腋窝淋巴结的状态分为腋窝淋巴结阳性组152例和腋窝淋巴结阴性组324例。观察并比较两组病人临床病理表现、生存情况,并分析复发后预后影响因素。结果两组病人的局部与区域复发情况差异无统计学意义(均P0.05)。两组病人的年龄、复发部位、雌激素受体(ER)及孕激素受体(PR)状态、人表皮生长因子受体2(HER-2)状态、无病间期、局部治疗和全身治疗差异均无统计学意义(均P0.05)。两组病人无远处转移生存率差异无统计学意义(P0.05),而阳性组患总生存率明显低于阴性组(P0.05)。Cox比例风险模型多因素分析显示,复发部位是乳腺癌保乳手术局部区域复发后无远处转移生存的独立影响因素(OR=2.052,P=0.003),腋窝淋巴结状态和复发部位是乳腺癌保乳手术局部区域复发后总生存的独立影响因素(OR=3.468,P=0.003;OR=677,P0.001)。结论腋窝淋巴结状态是乳腺癌保乳手术后复发病人总生存的独立影响因素,但对病人的无远处转移生存影响较小。     

腔镜腋窝淋巴结清扫与传统腋窝淋巴结清扫对保乳手术美容效果影响的比较

目的探讨腔镜腋窝淋巴结清扫在乳腺癌保乳手术中的美容效果。方法2007年1月-2009年12月保乳手术中行腔镜腋窝淋巴结清扫术29例（EALND组）,并与同期33例传统腋窝淋巴结清扫（CALND组）进行比较,根据调查问卷和术后6个月以上站立位乳房照片评价术后乳房的美容效果。结果EALND组无中转开放手术,未发生意外损伤、皮下气肿、脂肪栓塞等并发症。EALND组清扫腋窝淋巴结（18．2±5．9）枚,显著多于CALND组（14．9±3．6）枚（t=2．694,P=0．009）。平均随访时间49．2月（36—69个月）。EALND组主观满意度优良率89．7％（26／29）,明显高于CALND组69．7％（23／33;Z=-2．509,P=0．012）;EALND组美容效果客观评分优良率86．2％（25／29）,明显高于CALND组75．8％（25／33;Z=-2．295,P=0．022）。结论腔镜腋窝淋巴结清扫术不仅能够达到传统腋窝淋巴清扫的治疗效果,而且具有缩小手术切口、改善保乳手术后乳房美容效果等优点。     

乳腺癌乳腔镜腋窝淋巴结清扫手术的应用价值

<正>传统的乳腺癌手术可能存在一些固有缺陷。①常规腋窝淋巴结清扫手术(axillary lymph node dissection,ALND)可能引起如上肢功能障碍、水肿等难以纠正的并发症,一旦发生则缺少长期有效的治疗方法,而严重影响病人生活质量.     

哨兵淋巴结活检对预测乳腺癌腋窝淋巴结转移的价值

目的 评估哨兵淋巴结（ＳＮ）活检对预测乳腺癌腋窝淋巴结（ＬＮ）转移的价值。方法 本组５２例原发乳腺癌患者,临床及Ｂ超检测腋窝ＬＮ阴性。术中在原发肿瘤周围注射亚甲蓝进行腋窝淋巴结定位和哨兵淋巴结切除（ＳＬＮＤ）,随后行腋窝淋巴结清扫（ＡＬＮＤ）。术中对部分ＳＮ、术后对全部ＬＮ（ＳＮ和非ＳＮ）行常规病理检查。结果 ５２例患者中４６例检测到ＳＮ,成功率为８８．５％;其中４４例（９５．７％）和ＳＮ可以准确     

经乳晕保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌

目的探讨经乳晕或乳腔镜辅助保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌的效果. 方法 2001年8月～2003年11月,对19例直径<2 cm、距离乳头>2 cm的乳腺癌经乳晕或乳腔镜辅助行保乳手术,腋窝脂肪溶解抽吸后常规开放性腋窝淋巴结清扫. 结果 1例术中冰冻病理报告一侧切缘镜下癌残留,经扩大切除后转阴.术后2例乳房创面皮下积液,抽洗加压包扎消失.保留的乳房形态良好,伤口小而隐蔽,所有患者对手术效果满意.术后随访2～19个月,平均10.6月,未见乳腺和腋窝肿瘤复发. 结论经乳晕或乳腔镜辅助下,借助乳腔镜器械可以方便地完成乳腺癌保乳手术,联合常规腋窝淋巴结清扫,手术效果肯定.     

腋窝淋巴结转移率对乳腺癌患者预后的影响

目的 探讨淋巴结转移率(LNR)对腋窝淋巴结阳性乳腺癌患者预后的影响。方法 回顾性分析2012-01—2014-12月河南省妇幼保健院收治的201例腋窝淋巴结阳性乳腺癌患者的临床和病理资料,并进行随访。比较不同LNR患者的预后。结果 肿瘤较大、HER2阳性、病理淋巴结分期(pN)高,以及LNR高者的5 a总生存率(OS)较低(P<0.05)。pN1、pN2、pN3患者5 a的OS分别为99.32%、97.50%、30.77%,差异有统计学意义(P<0.01);而LNR≤0.30患者的OS为99.42%,LNR>0.30者的OS为58.62%,差异有统计学意义(P<0.01)。结论 LNR和pN对预测乳腺癌患者预后有相似的价值,且避免了因为淋巴结清扫数量差异带来的偏差,可作为pN的补充指标。     

前哨淋巴结活检联合保乳手术对乳腺癌患者CA125、CEA及HER-2表达的影响

目的 探讨前哨淋巴结活检联合保乳手术对乳腺癌患者糖类抗原125(CA125)、癌胚抗原（CEA）及人表皮生长因子受体2(HER-2)表达的影响。方法 入选本院2019年1月至2022年1月收治的乳腺癌患者70例为研究对象,按照不同治疗方案均分为两组,观察组35例患者予以保乳联合前哨淋巴结活检术治疗,对照组35例患者实施腋窝淋巴结清扫术。比较两组肩关节功能优良率,手术情况,生活质量评分,血清肿瘤标记物,HER-2表达及并发症发生率。结果 观察组优良率（97.14%）显著高于对照组（74.29%）(P<0.05);观察组手术时间、住院时间、总出血量、总引流量显著低于对照组（P<0.05）;观察组心理功能、社会功能、生活状态、躯体功能评分显著高于对照组（P<0.05）;观察组术后CA125、CEA水平显著低于对照组（P<0.05）;两组HER-2表达情况比较,无显著差异（P>0.05）;观察组并发症发生率（0%）显著低于对照组（20.00%）,有统计学意义（P<0.05）。结论 保乳手术结合前哨淋巴结活检治疗,创伤更小,能够有效改善患者肩关节功能,降低血清...     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

不同分型浸润性乳腺癌与腋窝淋巴结转移的相关性

目的:研究不同分型浸润性乳腺癌与腋窝淋巴结转移的相关性。方法:收集2013年1月—2015年1月于上海新华医院崇明分院接受乳腺癌手术治疗的102例患者。将所有受试者按照免疫组织化学及HER2荧光原位杂交结果的不同分为Luminal A型、Luminal B型、HER2阳性型及三阴性乳腺癌。比较不同分型乳腺癌患者的腋窝淋巴结转移情况、病理参数及预后情况。并以Logistic分析法明确乳腺癌患者预后不良的影响因素。结果:102例乳腺癌患者腋窝淋巴结转移率为34.65%,其中Luminal A型、Luminal B型、HER2阳性型及三阴性乳腺癌的腋窝淋巴结转移率分别为24.00%、41.46%、45.45%及14.29%。不同分型乳腺癌患者的腋窝淋巴结转移率差异无统计学意义(均P>0.05)。肿瘤直径≥5 cm的乳腺癌患者腋窝淋巴结转移率高于<5 cm的患者(P<0.05)。三阴性乳腺癌患者局部复发率高于其他分型乳腺癌患者,且HER2阳性型、三阴性乳腺癌患者的远处转移率均高于LuminalA型、LuminalB型,而三阴性乳腺癌患者存活率均低于其他分型乳腺癌患者(均P&l...     

乳腺癌乳腔镜腋窝淋巴结清扫术与常规手术的比较

目的比较乳腔镜腋窝淋巴结清扫术与常规腋窝淋巴结清扫术的优缺点。方法将2008年12月～2010年6月48例腔镜腋窝淋巴结清扫术与50例传统腋窝淋巴结清扫术的临床资料进行回顾性分析,比较2组手术时间、术中出血量、清扫淋巴结数目、住院时间、住院费用以及术后并发症的发生率。结果腔镜组手术时间(222.8±19.4)min显著长于常规组(140.1±13.9)min(t=24.333,P=0.000),腔镜组住院费用(18587.9±2055.8)元显著高于常规组(14203.8±1396.5)元(t=12.393,P=0.000),但腔镜组术中出血量(36.5±8.5)ml显著少于常规组(58.9±7.0)ml(t=-14.265,P=0.000),2组淋巴结清扫数目无统计学差异[(16.7±2.6)枚vs(15.9±4.8)枚,t=1.035,P=0.303]。2组随访未发现复发及远处转移。结论乳腔镜腋窝淋巴结清扫术具有创伤小、并发症少、瘢痕小等优点,值得推广,但腔镜操作缺乏触感,灵活性不足,延长了手术时间,增加了住院费用。     

腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用

目的:探讨腔镜腋窝淋巴结清扫治疗早期乳腺癌保乳手术的可行性及临床效果。方法:回顾分析98例早期乳腺癌行保乳手术的临床资料,其中41例行腔镜腋窝淋巴结清扫术(腔镜组),57例行常规腋窝淋巴结清扫术(常规组),比较两组手术时间、出血量、清扫淋巴结个数、阳性淋巴结数及并发症、预后等。结果:两组均完成手术。腔镜组与常规组平均手术时间分别为99.5 min与61.5 min(P<0.05),平均清扫出腋窝淋巴结数分别为17.6枚与18.6枚(P>0.05),平均阳性淋巴结数分别为2.1枚与2.4枚(P>0.05),平均手术出血量分别为35.4 mL与61.5 mL(P<0.05)。随访1～4年,腔镜组无复发及转移病例,未出现术后并发症。常规组1例出现患侧上肢水肿,1例乳房皮肤瘢痕愈合不良;1例乳房局部复发,1例肺转移,1例胫骨转移。两组均无死亡病例。结论:腔镜腋窝淋巴结清扫术与开放腋窝淋巴结清扫术同样能彻底完成腋窝淋巴结清扫,具有并发症少,美学效果好的优势。     

Outcome of breast-conserving treatment for axillary lymph node metastasis from occult breast cancer with negative breast MRI

PurposeWe conducted this study to investigate the prognosis and failure pattern after breast-conserving treatment (BCT) in patients with occult breast cancer (OBC) with negative breast magnetic resonance imaging (MRI) (MRI-OBC).Materials and methodsSurvival rates and failure patterns in 66 patients who received axillary lymph node dissection (ALND) and BCT for MRI-OBC between 2001 and 2013 at seven hospitals were analyzed. OBC was defined as adenocarcinoma in the axillary lymph node (ALN) +/− supraclavicular (SCN) or internal mammary lymph node (IMN) with a negative breast MRI.ResultsFifty-four patients had only ALN metastasis (ALN only), and 12 patients had ALN metastasis along with SCN or IMN metastasis (ALN + SCN/IMN). Median follow-up was 82 months. The 5-year overall, disease-free, and breast cancer-free survival rates were 93.4%, 92.1%, and 96.8%, respectively. Nine patients experienced recurrence: breast (n = 4), regional lymph nodes (RLN, n = 1), distant metastases (DM, n = 2), breast/RLN (n = 1), and breast/RLN/DM (n = 1). Five-year disease-free survival was significantly higher in ALN only patients compared to ALN + SCN/IMN patients (96.1% vs. 75.0%; p = 0.02).ConclusionsPatients with MRI-OBC were successfully treated with BCT. There was a small risk of ipsilateral breast cancer recurrence. Failure patterns depended on the extent of initial disease.     

Prediction of additional axillary metastasis of breast cancer following sentinel lymph node surgery

Sentinel lymphadenectomy is a sensitive and specific procedure that has reduced the need for complete axillary lymph node dissections in patients with negative sentinel lymph nodes (SLNs). However, numerous studies have shown that SLN may be the only positive lymph node in 40 to 70% of cases. This study was therefore undertaken to determine if the characteristics of primary breast tumor or its metastasis in the SLN could predict the presence of residual disease in the nonsentinel lymph nodes (NSLNs) and thus allow for further reduction in axillary lymph node surgery. The SLN procedure was performed on 329 patients at our institution, of which 131 had positive SLNs and underwent further axillary surgery. Fifty-four patients had additional disease in the NSLNs, while in the remaining 77 cases, no residual disease was detected. The clinical and pathologic features of these cases were reviewed and statistical analysis was performed. Multivariate analysis determined two significant independent variables for prediction of residual disease in the axilla: the size of the metastatic tumor in SLNs and the presence of its extranodal extension. The mean tumor size in SLNs without residual disease in NSLNs was 0.4 cm. It was 1.1 cm in patients with additional NSLN metastasis. The positive predictive value in both instances is about 80%. The risk of NSLN involvement in patients with SLN tumors of < or = 0.4 cm was 21%. The risk was the same (21%) for patients with micrometastatic disease (< or = 0.2 cm) in SLNs. In these cases the residual disease in the NSLNs was also small. SLNs with metastatic deposits larger than 1.0 cm were likely to contain additional metastases in the NSLNs in 81% of cases. This increased to 100% if the primary carcinoma was larger than 5 cm, if it was poorly differentiated, or if it showed HER-2/neu gene amplification. The presence of an extranodal extension of SLN metastasis was an independent predictor of residual axillary disease and was associated with NSLN metastasis in 76% of cases. Primary tumor characteristics did not correlate with the incidence of NSLN metastasis in our series.     

乳腺癌前哨淋巴结活检对腋窝淋巴结转移的预警价值研究

目的探讨乳腺癌前哨淋巴结(sentinel lymph node,SLN)预警腋窝淋巴结转移的价值. 方法对56例乳腺癌行亚甲蓝前哨淋巴结定位、活检和腋窝淋巴结清扫术,标本常规行HE染色、免疫组化病理检查. 结果 SLN成功检出52例(52/56,92.8%),常规病理检查证实SLN转移22例;SLN无转移,但非SLN发现转移者1例,假阴性率为4.3%(1/23).常规病理检查无转移的29例患者,免疫组化检测发现1例CK-19( )、EMA( ),另1例CK-19( ),CEA( ),而所属非前哨淋巴结无肿瘤转移. 结论乳腺癌亚甲蓝前哨淋巴结定位、活检可以预示腋窝淋巴结转移.     

High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer

To determine ultrasound (US) features that most accurately predict the presence of axillary lymph node metastasis, we retrospectively analysed the results of preoperative US breast examinations of axillary lymph nodes in 425 consecutive patients who subsequently underwent surgery for invasive breast cancer. We compared the US findings with pathologic results for axillary lymph node metastasis. US features included length of the longest (L) and shortest (S) axes, L/S ratio, cortical thickness, presence of hilum and shape. The results of multivariate logistic regression analysis revealed that cortical thickness greater than 3 mm was the most accurate indicator, with 4.14 times increased risk of the presence of an axillary lymph node metastasis as compared to cortical thickness less than 3 mm. The absence of a hilum showed the highest specificity for axillary lymph node metastasis (94.6%), but low sensitivity.     

201例乳腺癌患者腋淋巴结转移的临床研究

目的 探讨乳腺癌腋窝肿块的位置、大小与腋窝淋巴结转移的关系。方法 应用SPSS13．0统计分析软件，前瞻性分析2000年11月至2007年10月间201例乳腺癌患者腋窝I、Ⅱ、Ⅲ组以及胸肌间淋巴结（Rotter）转移情况。结果 201例乳腺癌患者中，腋窝淋巴结存在转移者104例（51．74％）；随肿瘤体积的增大，腋窝I、Ⅱ、Ⅲ组淋巴结的转移率均明显增高；外、中、内三个带区的乳腺癌在各级腋淋巴结的转移率上无显著统计学差异；胸肌间淋巴结发现率和转移率较低。结论 应重视对乳腺癌患者尤其是肿瘤体积大、分期晚的病人腋窝Ⅲ组淋巴结的清扫；不应随意放弃全腋淋巴结清扫术；不应将肿瘤的生长位置作为判断腋窝淋巴结是否存在转移的依据；在手术过程中应当将胸肌间淋巴结一并清扫。     

数字化钼靶检查在判断乳腺癌腋窝淋巴结转移中的价值探讨

目的探讨全数字化钼靶X线摄影在判断乳腺癌有无腋窝淋巴结转移方面的价值。方法收集经术后病理证实的乳腺癌患者260例和门诊乳腺增生患者110例,全部病例均有数字化钼靶摄影。综合分析腋窝淋巴结在钼靶X线摄影上的特点。结果乳腺增生的钼靶片显示,腋窝淋巴结数目及大小不一,边界清楚,形态多样,以类圆形多见,密度大多不均质,淋巴结外腋窝组织清晰;乳腺癌钼靶片显示,腋窝淋巴结可疑阳性者,其数目和大小与乳腺增生相比无特异性,但密度多较均质,以椭圆形或圆形多见,边界不清,淋巴结周围组织紊乱;而淋巴结阴性者,其密度多不均匀,呈现中心密度低,周边密度高的壳状。结论术前通过对钼靶影像腋窝淋巴结的密度、边界、形态及周围组织结构的比较分析,可以初步了解腋窝淋巴结有无转移,有助于对乳腺癌患者的整体了解和选择治疗方案。     

超声引导针吸活检术评价乳腺癌腋窝淋巴结转移

目的 研究超声引导针吸活检在术前判断乳腺癌腋窝淋巴结转移中的应用,评价该方法的可行性和诊断的准确率. 方法对40例腋窝触诊阴性的高度可疑乳腺癌患者的40个腋窝淋巴结进行超声引导针吸活检,将结果与前哨淋巴结活检或腋窝淋巴结清扫的组织学病理结果进行对照.分析超声引导针吸活检判断乳腺癌腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率.结果 40例患者全部经病理证实为浸润性乳腺癌.超声引导针吸活检判断腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为52.2%、100%、100%、60.7%、72.5%.有12例(30%)术前细针穿刺活检阳性的患者避免了前哨活检,直接接受了腋窝清扫.结论 应用超声引导针吸活检在术前判断乳腺癌的腋窝淋巴结转移情况创伤小、特异性高,可以避免部分患者接受前哨淋巴结活检术.

Abstract：

Objective To study the utilization of preoperative ultrasound-guided fine-needle aspiration(USFNA) for axillary lymphnode(ALN) metastasis in breast cancer and to evaluate the feasibility and accuracy of the technique. Methods Forty ALNs in 40 armpit negative palpation highly suspective breast cancer patients underwent USFNA. The cytopathological results were compared with the histopathological results of sentinel lymphnode(SLN) biopsy or axillary lymphnode dissection(ALND). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of USFNA for the ALN metastasis were analysed. Results All the 40 patients were confirmed with breast cancer by pathology. Sensitivity of USFNA was 52. 2%, specificity was 100%, PPV was 100%,NPV was 60. 7% and diagnostic accuracy was 72. 5%. 12(30% ) patients with positive cytology proceeded to ALND, avoiding SLN biopsy. Conclusions USFNA is a minimally invasive, highly specified technique for prediction of breast cancer ALN metastasis before operation.