Neslihan Cabıoğlu, Hasan Karanlık, Ravza Yılmaz, Selman Emiroğlu, Mustafa Tükenmez, Süleyman Bademler, Duygu Has Şimşek, Tarık Recep Kantarcı, İnci Kızıldağ Yirgin, Aysel Bayram, Memduh Dursun
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Our objective was to assess the feasibility of the removal of the clipped node (RCN) with TAD or without imaging-guided localisation by SLNB to reduce the residual axillary disease in completion axillary lymph node dissection (cALND) in cN+ breast cancer.</p><p><strong>Methods: </strong>A combined analysis of two prospective cohorts, including 253 patients who underwent SLNB with/without TAD and with/without ALND following NAC, was performed. Finally, 222 patients (cT1-3N1/ycN0M0) with a clipped lymph node that was radiologically visible were analyzed.</p><p><strong>Results: </strong>Overall, the clipped node was successfully identified in 246 patients (97.2%) by imaging. Of 222 patients, the clipped lymph nodes were non-SLNs in 44 patients (19.8%). Of patients in cohort B (n=129) with TAD, the clipped node was successfully removed by preoperative image-guided localisation, or the clipped lymph node was removed as the SLN as detected on preoperative SPECT-CT. Among patients with ypSLN(+) (n=109), no significant difference was found in non-SLN positivity at cALND between patients with TAD and RCN (41.7% vs. 46.9%, p=0.581). In the subgroup with TAD with axillary lymph node dissection (ALND; n=60), however, patients with a lymph node (LN) ratio (LNR) less than 50% and one metastatic LN in the TAD specimen were found to have significantly decreased non-SLN positivity compared to others (27.6% vs. 54.8%, p=0.032, and 22.2% vs. 50%, p=0.046).</p><p><strong>Conclusions: </strong>TAD by imaging-guided localisation is feasible with excellent identification rates of the clipped node. 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引用次数: 0
摘要
背景：在临床结节阳性（cN+）的乳腺癌患者中，与前哨淋巴结（SLN）活检（SLNB）相比，有针对性的腋窝清扫术（TAD）是否具有优势还存在争议。我们的目的是评估在对 cN+ 乳腺癌患者进行腋窝淋巴结清扫术（cALND）时，使用 TAD 或不使用 SLNB 在影像学引导下定位，切除剪切的结节（RCN）以减少残留腋窝疾病的可行性：对两个前瞻性队列进行了综合分析，其中包括 253 例在 NAC 后接受/不接受 TAD 的 SLNB 和接受/不接受 ALND 的患者。最后，分析了222例在放射学上可见剪切淋巴结的患者（cT1-3N1/ycN0M0）：结果：总体而言，246 例患者（97.2%）通过影像学检查成功确定了剪切的淋巴结。在 222 例患者中，有 44 例（19.8%）患者的剪切淋巴结为非淋巴结。在队列 B（n=129）的 TAD 患者中，通过术前图像引导定位成功切除了被剪切的淋巴结，或将被剪切的淋巴结作为术前 SPECT-CT 检测到的 SLN 予以切除。在 ypSLN(+) 患者（n=109）中，TAD 和 RCN 患者在 cALND 时的非 SLN 阳性率无显著差异（41.7% 对 46.9%，p=0.581）。然而，在进行腋窝淋巴结清扫（ALND；n=60）的TAD亚组中，发现淋巴结（LNR）比值（LNR）小于50%且TAD标本中有一个转移LN的患者与其他患者相比，非淋巴结阳性率显著降低（27.6% vs. 54.8%，p=0.032；22.2% vs. 50%，p=0.046）：结论：通过影像引导定位进行 TAD 是可行的，对切除结节的识别率极高。结论：在影像引导下进行 TAD 定位是可行的，其剪切结节的识别率极高，这种方法还能降低额外的非 SLN 阳性率，从而鼓励转移负荷较低的患者在接受 TAD 时放弃 ALND。
Targeted axillary dissection reduces residual nodal disease in clinically node- positive breast cancer after neoadjuvant chemotherapy.
Background: Any advantage of performing targeted axillary dissection (TAD) compared to sentinel lymph node (SLN) biopsy (SLNB) is under debate in clinically node-positive (cN+) patients diagnosed with breast cancer. Our objective was to assess the feasibility of the removal of the clipped node (RCN) with TAD or without imaging-guided localisation by SLNB to reduce the residual axillary disease in completion axillary lymph node dissection (cALND) in cN+ breast cancer.
Methods: A combined analysis of two prospective cohorts, including 253 patients who underwent SLNB with/without TAD and with/without ALND following NAC, was performed. Finally, 222 patients (cT1-3N1/ycN0M0) with a clipped lymph node that was radiologically visible were analyzed.
Results: Overall, the clipped node was successfully identified in 246 patients (97.2%) by imaging. Of 222 patients, the clipped lymph nodes were non-SLNs in 44 patients (19.8%). Of patients in cohort B (n=129) with TAD, the clipped node was successfully removed by preoperative image-guided localisation, or the clipped lymph node was removed as the SLN as detected on preoperative SPECT-CT. Among patients with ypSLN(+) (n=109), no significant difference was found in non-SLN positivity at cALND between patients with TAD and RCN (41.7% vs. 46.9%, p=0.581). In the subgroup with TAD with axillary lymph node dissection (ALND; n=60), however, patients with a lymph node (LN) ratio (LNR) less than 50% and one metastatic LN in the TAD specimen were found to have significantly decreased non-SLN positivity compared to others (27.6% vs. 54.8%, p=0.032, and 22.2% vs. 50%, p=0.046).
Conclusions: TAD by imaging-guided localisation is feasible with excellent identification rates of the clipped node. This approach has also been found to reduce the additional non-SLN positivity rate to encourage omitting ALND in patients with a low metastatic burden undergoing TAD.
期刊介绍：
World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics.
Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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