1679例乳腺癌内乳淋巴结转移的高危因素分析

目的 探讨乳腺癌内乳淋巴结转移的高危因素。方法回顾性分析复旦大学附属肿瘤医院乳腺外科1956-2003年开展的l679例乳腺癌扩大根治术临床资料,选取病人年龄、肿瘤大小、肿瘤位置、腋窝淋巴结转移状况共4个乳腺癌内乳淋巴结转移可能相关的因素,分析不同情况下内乳淋巴结转移的高危因素。结果在选取的4个因素中,肿瘤大小不是影响内乳淋巴结转移的独立因素。腋窝淋巴结状况为内乳淋巴结转移的重要影响因素。不同情况下,肿瘤位置和年龄对内乳淋巴结转移的影响也不同。腋窝淋巴结阴性病人的内乳淋巴结转移率为4．4％,腋窝淋巴结1-3个阳性为18．8％,腋窝淋巴结4-6个阳性为28．1％,腋窝淋巴结≥7个为41．5％。结论有4个或以上腋窝淋巴结转移、内侧肿瘤合并腋窝淋巴结转移、肿瘤直径〉5．0cm的年轻病人是内乳淋巴结转移率的高危病人。     

乳腺癌内乳淋巴结的临床研究

目的 探讨乳腺癌内乳淋巴结的临床意义及合理的手术方式.方法 对我院29例符合内乳淋巴结转移高危因素的患者,行内乳淋巴结清扫术,分区送检淋巴结标本.结果 29例患者共检出内乳淋巴结转移12例.结论 乳腺癌内乳淋巴结的转移对乳腺癌的精确分期及判断预后均有重要价值,是临床上不容忽视的问题.内乳淋巴结清除术损伤小、并发症少,可在临床研究中采用.对于乳腺癌患者尤其是伴有高危因素的患者,内乳淋巴结的引流状态值得进一步研究.     

乳腺癌内乳淋巴结检查方式

淋巴结状态是乳腺癌治疗中的一项重要指标,目前腋窝淋巴结(ALN)处理已有标准模式,而内乳淋巴结(IMLN)作为仅次于ALN的重要引流途径,由于其检查困难而无明确处理方式.随着技术的进步,不同的检查方式被用于IMLN的临床检查中.目前,临床上常用的检查方式有解剖影像学、功能影像学及有创的内乳前哨淋巴结活检(IM-SLNB...     

初诊M0伴内乳淋巴结和（或）锁骨上淋巴结转移乳腺癌临床诊治指南（2023版）

<正>追求最大获益和最小伤害理念是进展期乳腺癌诊治的基本原则。第8版美国癌症联合委员会(AJCC)乳腺癌分期标准定义内乳淋巴结转移为N2b或N3b,锁骨上淋巴结转移为N3c^[1]。为提高我国内乳淋巴结和(或)锁骨上淋巴结转移乳腺癌规范化诊治水平,中华医学会外科学分会乳腺外科学组组织专家针对相关临床问题进行文献收集和讨论,     

乳腺癌内乳前哨淋巴结活检的研究现状

区域淋巴结转移是乳腺癌最重要的预后指标。大量资料表明同时伴有腋淋巴结和内乳淋巴结转移的乳腺癌患者预后较差，以往随机临床试验证实内乳淋巴结清扫并不能提高患者的生存率；而该区的放疗因对心脏的潜在毒性而存在广泛争议。然而近十年来，前哨淋巴结活检的应用重新唤起了人们对内乳淋巴结转移的研究兴趣。乳腺癌内乳前哨淋巴结活检在完善分期的基础上，指导辅助治疗，并且在辅助放疗的靶区选择上达到了充分的共识。本文阐述了内乳淋巴结转移及其在乳腺癌中的预后、分期和治疗中的作用，以及内乳前哨淋巴结研究的最新进展。     

乳腺内乳淋巴结在乳腺癌诊治中的临床意义

目的探讨乳腺内乳淋巴结在乳腺癌诊治中的临床意义.方法通过分析国内、外关于内乳淋巴结的相关研究,总结乳腺癌中乳腺内乳淋巴结的分布、转移、检测及临床治疗的效果. 结果乳腺内乳淋巴结主要分布在胸骨附近,沿胸内乳动、静脉走行,在乳腺癌中能够发生早期转移且转移率随腋淋巴结转移数目的增多而增加,对内乳淋巴结的活检和治疗能影响乳腺癌患者的预后.结论内乳淋巴结的活检和治疗有助于乳腺癌的精确分期、治疗和预后判断, 同时也是防止乳腺癌复发的有效手段.     

肝内胆管细胞癌淋巴结转移诊治的进展

肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)是起源于二级胆管以上的胆管上皮恶性肿瘤,其发病率仅次于肝细胞癌,成为肝脏第二大原发性恶性肿瘤。近年来,其在世界范围内发病率及病死率均有所上升。肝内多发病灶、血管受累、淋巴结转移以及肿瘤组织学特征等都与ICC的预后相关 ~([1]),而淋巴结转移是公认的影响预后的首要因     

内乳淋巴结活检在乳腺癌分期与辅助治疗中的价值

目的分析乳腺癌经肋间隙内乳淋巴结切除活检在乳腺癌分期与辅助治疗中的价值。方法回顾性分析济南军区总医院甲状腺乳腺外科2003年5月至2014年1月期间305例（根据是否行新辅助化疗分为新辅助化疗组和无新辅助化疗组）行乳腺癌各式改良根治术与经肋间隙内乳淋巴结切除活检患者的相关临床与病理资料,包括患者年龄、腋窝淋巴结、内乳淋巴结转移状况等信息,分析内乳淋巴结对乳腺癌分期与治疗的影响。结果新辅助化疗组共收集乳腺癌患者67例,发生腋窝淋巴结转移者45例（67．2％）,内乳淋巴结转移者23例（34．3％）;乳腺癌淋巴结病理（pN）分期改变者23例（34．3％）,乳腺癌肿瘤病理（pTNM）分期改变者8例（11．9％）。无新辅助化疗组共收集乳腺癌患者238例,发生腋窝淋巴结转移者155例（65．1％）,内乳淋巴结转移者30例（12．6％）;乳腺癌pN分期改变者30例（12．6％）,pTNM分期改变者23例（9。66％）。新辅助化疗组的内乳淋巴结转移率明显高于无新辅助化疗组（χ2=15．7,P〈0．05）,pTNM分期改变率也明显高于无新辅助化疗组贸（χ2=5．3,P〈0．05）。结论经肋间隙内乳淋巴结活检对乳腺癌pN分期、pTNM分期有一定的影响。新辅助化疗不能使所有内乳淋巴结转移癌达到病理完全缓解。经肋间隙内乳淋巴结活检不仅可完善乳腺癌pN和pTNM分期,而且能够指导乳腺癌术后辅助治疗,减少内乳区局部过度治疗,有助于乳腺癌患者个体化治疗。     

内乳淋巴结状态与乳腺癌转移复发的相关性分析

目的:探讨内乳淋巴结状态与乳腺癌转移复发的相关性。方法:对收治的100例乳腺癌并内乳淋巴结转移患者内乳淋巴结术后大小、转移情况以及长度厚度比进行比较,根据患者淋巴结情况将其分为增大组、减少组以及未变化组,同时根据患者随访结果将其分为转移复发组、未转移复发组。并以健康体检人群50例作为对照组。结果:对患者淋巴结增大组、减少组以及未变化组其乳腺癌复发转移率分别为61.54%,6.90%,6.25%(P<0.05);转移复发组、未转移复发组以及健康对照组内乳淋巴结长度厚度比分别为1.55±0.82,2.73±0.53,2.69±0.71(P<0.05),转移复发组明显小于健康组以及未转移复发组患者。结论:淋巴结的状态可作为一种观测指标,为临床治疗以及预后提供间接参考。     

Stage migration after biopsy of internal mammary chain lymph nodes in breast cancer patients

Background Involvement of the internal mammary chain lymph nodes (IMNs) is associated with worsened prognosis in breast cancer. Use of lymphoscintigraphy to visualize sentinel nodes reveals that IMNs often receive lymph from the area containing the tumor. Methods We biopsied IMNs in 182 patients because there was radiouptake to the IMNs or because the tumor was located in the medial portion of the breast. After tumor removal, pectoralis major fibers were divided to expose intercostal muscle. A portion of intercostal muscle adjacent to the sternum was removed. Lymph nodes and surrounding fatty tissue in the intercostal space were freed, removed, and analyzed histologically. The pleural cavity was breached in four cases (2.2%), with spontaneous resolution. Results IMNs were found in 160 (88%) of 182 patients; 146 (94.4%) were negative and 14 (8.8%) were positive. The latter received internal mammary chain radiotherapy. The axilla was negative in 4 of 14 cases and positive in 10. Conclusions IMNs can be quickly and easily removed via the breast incision with insignificant risk and no increase in postoperative hospitalization. The patients with a positive IMN migrated from N0 (4 cases) or N1 (10 cases) to N3, prompting modification of both local (radiotherapy to internal mammary chain) and systemic treatment; without IMN sampling, they would have been understaged.     

Management of axillary and internal mammary lymph nodes in primary breast cancer]

Axillary lymph node dissection (ALND) is an effective staging procedure and is essential for local control of breast cancer. The regimen of the adjuvant systemic therapy is largely based on the number of nodes involved. There is as yet no evidence of survival benefit from axillary treatment by either surgery or radiotherapy, but this issue remains controversial. In general, the standard treatment of the axilla is surgical clearance of nodes from level I and II (partial ALND). If these nodes are involved, the clearance of level III nodes (complete ALND) is indispensable from the viewpoint of local control. Because a high rate of adverse events is observed, the extent of ALND should be determined by considering the balance between side effects and therapeutic benefit on a case-by-case basis. For the management of internal mammary nodes, most reports on randomized trials indicate that neither surgical treatment nor radiotherapy influences survival. However, the prognostic significance of internal mammary node status is high and a selected biopsy of lymph nodes with adenopathy should be considered for staging purposes. The significance of local control in this region is still controversial at present. About 30% to 40% of all invasive breast cancers are node positive. Thus, in most cases, the potential morbidity of ALND could be avoided if the status of the axillary nodes was ascertained with a less invasive procedure. The technique of sentinel lymph node biopsy may eventually prove to decrease the need for standard ALND. The randomized trial NSABP-B32 is ongoing and the results should indicate the clinical need for ALND.     

Results of tailored treatment for breast cancer patients with internal mammary lymph node metastases

Although the internal mammary (IM) lymph node status is a major prognostic factor in breast cancer, IM nodal staging is not common practice. In order to improve nodal staging, we have routinely performed IM sentinel node (SN) biopsy and have adjusted adjuvant treatment accordingly. We reviewed the outcome of these patients. Data from 764 patients were available for follow-up. A total of 406 patients had no lymph node metastases (group 1), 330 patients had axillary metastases (group 2), 7 patients had IM metastases only (group 3) and 21 patients had both axillary and IM metastases (group 4). Mean follow-up was 46 months. Prognosis did not appear to be worse for patients with IM metastases compared to those with axillary metastases only, which might indicate that they benefit from improved staging and tailored adjuvant treatment algorithms. However, long-term follow-up data, preferably in larger series, are needed to support our findings.     

乳腺癌内乳区前哨淋巴结活检术研究进展

内乳区淋巴结的转移状况是乳腺癌的独立预后指标,也：是乳腺癌淋巴分期的重要依据之一。内乳区淋巴结转移的患者预后较差。随着前哨淋巴结活检技术的不断发展和新型注射技术的出现,内乳区前哨淋巴结活检的显像率显著提高,经肋间行内乳区前哨淋巴结活检术可以最小的风险评估内乳区淋巴结状况,并进一步完善乳腺癌的淋巴结分期．有助于为患者制定更为准确的个体化治疗方案。     

Reappraisal of internal mammary lymph node dissection in selected patients with invasive breast cancer

We performed a new type of en bloc extended radical mastectomy (EXT) as a clinical trial in 118 patients from 1980 through 1985. A variety of conventional radical mastectomies (RDL) were also undertaken in 105 patients from 1973 through 1985. In this retrospective study, univariate and multivariate analyses were performed to compare the results of EXT and RDL. The univariate analysis showed that the 10-year survival rates for the EXT and the RDL groups were 86% ± 3.3% and 77% ± 4.2%, respectively (P = 0.073 with the Cox-Mantel test). For the subgroups stratified according to the status of axillary lymph node involvement, the EXT was significantly better in patients with one to three metastatic axillary lymph nodes (P = 0.016). The adjusted Cox regression analysis revealed that the favorable results of EXT were most encouraging in the patients with one to three metastatic axillary lymph nodes (P = 0.058). Therefore, it is suggested that an EXT may be more advantageous than RDL in selected patients with resectable invasive breast cancer.     

Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer

OBJECTIVE: To determine whether subtumoral injection of radiocolloid is useful for lymphoscintigraphic visualization of the internal mammary node and in sentinel lymph node (SLN) biopsy of the axilla in breast cancer patients. SUMMARY BACKGROUND DATA: The presence of retromammary lymphatics connecting to the axillary and internal mammary basins has been demonstrated by early anatomic studies. Thus, it is hypothesized that some lymph, especially that from the parenchyma under the tumor, may drain into both the axillary and internal mammary basins. METHODS: Patients (n = 196) with T1-2, N0 breast cancer underwent preoperative lymphoscintigraphy with radiocolloid (technetium 99m tin colloid) injection into various sites of the breast, followed by SLN biopsy using the combined method with blue dye. Patients were divided into four groups: group A (n = 41), peritumoral injection of both radiocolloid and blue dye; group B (n = 70), periareolar radiocolloid and peritumoral blue dye; group C (n = 45), intradermal radiocolloid and periareolar blue dye; and group D (n = 40), subtumoral radiocolloid and intradermal blue dye. A retrospective analysis of 1,297 breast cancer patients who underwent extended radical mastectomy with internal mammary node dissection was also conducted to determine the relationship between vertical tumor location (superficial or deep) and frequency of axillary and internal mammary node metastases. RESULTS: One patient (2%) in group A, 3 (4%) in group B, 0 (0%) in group C, and 15 (38%) in group D exhibited hot spots in the internal mammary region on lymphoscintigraphy (P <.001, group D vs. the other groups). The concordance rate of radiocolloid and blue dye methods in detection of SLNs in the axillary basin was significantly lower in group D than in the other groups. In contrast, the mismatch rate (some SLNs were identified by radiocolloid and other SLNs were identified by blue dye, but no SLN was identified by both in the same patient) was significantly higher in group D than in the other groups. In patients treated with extended radical mastectomy, positivity of axillary and internal mammary metastases was significantly higher in patients (n = 215) with deep tumors than those (n = 368) with superficial tumors. CONCLUSIONS: These results suggest the presence of a retromammary lymphatic pathway from the deep portion of the breast to both axillary and internal mammary basins, which is distinct from the superficial pathway. Therefore, SLN biopsy with a combination of subtumoral and other (peritumoral, dermal, or areolar) injections of radiocolloid will improve both axillary and internal mammary nodal staging.     

内乳淋巴结在乳腺癌治疗中的重要性

目的探讨乳腺癌术后内乳淋巴结复发的原因,强调内乳淋巴结在乳腺癌治疗中的重要性。方法回顾性分析40例以内乳淋巴结转移为首先复发的女性乳腺癌患者的临床资料、初发病时的临床特征、手术方式、术后病理分期以及治疗经过。结果40例患者内乳淋巴结复发与患者年龄、经期状况、手术方式无关(P>0.05)。而与原发肿瘤直径、部位、腋窝淋巴结阳性数、临床病理分期相关(P<0.05)。结论位于乳腺内侧区、中央区的大块肿瘤(>3cm),腋窝淋巴结阳性数多(>3),且临床病理分期晚(IIb IIIab)的乳腺癌患者,内乳淋巴结转移机率较高,须加强术后综合治疗。     

The thoracoscopic approach for internal mammary nodes in breast cancer

Background: This pilot study was conducted to estimate the use of the thoracoscopic surgery as a new approach for the internal mammary nodes (IMN) in breast cancer. Patients and methods: For this study, 21 women with breast cancer who underwent the approach for nodes IMN were enrolled. All the women had suspicious IMN metastasis and no distant metastasis. Results: Thoracoscopic IMN dissection was performed safely for 20 of the women, with an average operative time of 44 min. One woman was excluded from the procedure because of pleural adhesion. The patients were restricted from walking for 1.3 days because of chest drainage, but no patients had severe complication or chest wall deformity after the operation. Six patients had positive IMN outcomes. After surgery, 10 of the 20 patients had a lower tumor node metastases (TNM) staging. Two patients who tested positive for IMN and three who tested negative experienced a relapse, but none had pleural dissemination in a median follow-up period of 24 months. Conclusion: Thoracoscopic surgery may be useful in managing patients with IMN. Received: 2 June 1999/Accepted: 17 January 2000/Online publication: 29 August 2000     

Prognostic significance of internal mammary lymph node metastases in breast cancer patients]

Examination was made of clinical, histological and biological prognostic factors in 207 patients with invasive breast cancer, and determination was made as to whether variable prognostic factors, especially internal mammary lymph node metastases, would serve as a basis for the prognosis of breast cancer. In a univariate study, overall survival was significantly corrected with tumor size, axillary lymph node status, axillary and internal mammary lymph node metastases and DNA ploidy status. In a multivariate study, however, only axillary and internal mammary lymph node metastases were recognized as important, and independent prognostic factors on survival. Neither axillary lymph node status nor DNA ploidy status appeared an important prognostic factor. Axillary and internal mammary lymph node metastases could not be predicted from their clinical assessment. Only axillary lymph node dissection and biopsy of first and second intercostal spaces were concluded to be useful for accurately indicating the status of these lymph nodes.