乳腺导管原位癌切除术中选择性省略前哨淋巴结活检:确定符合条件的候选者

IF 6.1 1区 医学 Q1 ONCOLOGY Breast Cancer Research Pub Date : 2024-04-12 DOI:10.1186/s13058-024-01816-7
Soong June Bae, Yoonwon Kook, Ji Soo Jang, Seung Ho Baek, Sohyun Moon, Jung Hyun Kim, Seung Eun Lee, Min Ji Kim, Sung Gwe Ahn, Joon Jeong
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引用次数: 0

摘要

前哨淋巴结活检(SLNB)适用于接受乳房切除术的乳腺导管原位癌(DCIS)患者,这是因为考虑到乳房切除术后 SLNB 的上行分期和技术难度。然而,考虑到 DCIS 的良好预后和去升级趋势,这可能会导致潜在的过度治疗。有关这些患者上行分期和腋窝淋巴结转移的数据仍然有限。我们回顾性研究了2010年1月至2021年12月期间在江南 Severance 医院接受乳房切除术并行 SLNB 或腋窝淋巴结清扫术的 DCIS 患者。为了探讨省略 SLNB 的可行性,我们评估了 DCIS 升级为浸润癌和腋窝淋巴结转移的比率。我们进行了二元 Cox 回归分析,以确定与升期和腋窝淋巴结转移相关的临床病理因素。在385名患者中,164人(42.6%)经历了浸润癌升级:分别有53人(13.8%)、97人(25.2%)和14人(3.6%)证实为微小浸润、pT1和pT2。17例(4.4%)患者有腋窝淋巴结转移。多变量分析发现,年龄小于 50 岁(调整后的比值比 [OR],12.73;95% 置信区间 [CI],1.18-137.51;P = 0.036)和放射学评估发现可疑腋窝淋巴结(调整后的比值比 [OR],9.31;95% 置信区间 [CI],2.06-41.99;P = 0.004)是腋窝淋巴结转移的独立相关因素。在年龄大于50岁和/或无可疑腋窝淋巴结的患者中,仅有1.7%-2.3%发生了腋窝淋巴结转移。虽然在接受乳房切除术的DCIS患者中,侵袭性成分的低估率相对较高,但腋窝淋巴结转移却很少见。我们的研究结果表明,对于 50 岁以上和/或在放射学评估中没有可疑腋窝淋巴结的患者,省略 SLNB 是可行的。
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Selective omission of sentinel lymph node biopsy in mastectomy for ductal carcinoma in situ: identifying eligible candidates
Sentinel lymph node biopsy (SLNB) is recommended for patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, given the concerns regarding upstaging and technical difficulties of post-mastectomy SLNB. However, this may lead to potential overtreatment, considering favorable prognosis and de-escalation trends in DCIS. Data regarding upstaging and axillary lymph node metastasis among these patients remain limited. We retrospectively reviewed patients with DCIS who underwent mastectomy with SLNB or axillary lymph node dissection at Gangnam Severance Hospital between January 2010 and December 2021. To explore the feasibility of omitting SLNB, we assessed the rates of DCIS upgraded to invasive carcinoma and axillary lymph node metastasis. Binary Cox regression analysis was performed to identify clinicopathologic factors associated with upstaging and axillary lymph node metastasis. Among 385 patients, 164 (42.6%) experienced an invasive carcinoma upgrade: microinvasion, pT1, and pT2 were confirmed in 53 (13.8%), 97 (25.2%), and 14 (3.6%) patients, respectively. Seventeen (4.4%) patients had axillary lymph node metastasis. Multivariable analysis identified age ≤ 50 years (adjusted odds ratio [OR], 12.73; 95% confidence interval [CI], 1.18–137.51; p = 0.036) and suspicious axillary lymph nodes on radiologic evaluation (adjusted OR, 9.31; 95% CI, 2.06–41.99; p = 0.004) as independent factors associated with axillary lymph node metastasis. Among patients aged > 50 years and/or no suspicious axillary lymph nodes, only 1.7–2.3%) experienced axillary lymph node metastasis. Although underestimation of the invasive component was relatively high among patients with DCIS undergoing mastectomy, axillary lymph node metastasis was rare. Our findings suggest that omitting SLNB may be feasible for patients over 50 and/or without suspicious axillary lymph nodes on radiologic evaluation.
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来源期刊
Breast Cancer Research
Breast Cancer Research 医学-肿瘤学
自引率
0.00%
发文量
76
期刊介绍: Breast Cancer Research is an international, peer-reviewed online journal, publishing original research, reviews, editorials and reports. Open access research articles of exceptional interest are published in all areas of biology and medicine relevant to breast cancer, including normal mammary gland biology, with special emphasis on the genetic, biochemical, and cellular basis of breast cancer. In addition to basic research, the journal publishes preclinical, translational and clinical studies with a biological basis, including Phase I and Phase II trials.
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