乳腺癌前哨淋巴结微转移_West China Medical Journal

Authors：

姜燕 ¹ ,  李宏江 ²

Corresponding author：

李宏江, Email: ab.cwd@163.com

Keywords：

乳腺癌; 前哨淋巴结; 微转移

Video：

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【摘要】　乳腺癌是女性最常见的恶性肿瘤之一，腋窝淋巴结的转移状况是乳腺癌患者最有价值的预后因素。乳腺癌前哨淋巴结活检术的开展有望替代腋窝淋巴结清扫术，从而减少甚至避免腋窝淋巴结清扫带来的疼痛、麻木、水肿、运动障碍等并发症。常规病理技术无法确定存在于淋巴结的微转移灶，而这些微转移灶对乳腺癌的诊断、分期复发与预后判断、综合治疗的选择具有极其明显的意义。较高的假阴性率是前哨淋巴结活检的不利因素，不仅导致分期不准确，更重要的是影响了患者最佳治疗方案的制定。对前哨淋巴结微转移的检测可以提高分期的准确性，改变一部分患者的治疗决策。现就乳腺癌前哨淋巴结微转移的相关情况做一综述。

Citation： 姜燕,李宏江. 乳腺癌前哨淋巴结微转移. West China Medical Journal, 2011, 26(7): 995-999. doi: Copy

1.	Kapur U, Rubinas T, Ghai R, et al. Prediction of nonsentinel lymph node metastasis in sentinel node-positive breast carcinoma[J]. Ann Diagn Pathol, 2007, 11(1): 10-12.
2.	Benson JR, Della QG, Group MA. Management of the axilla in women with breast cancer[J]. Lancet Oncol, 2007, 8(4): 331-348.
3.	Ismail Jatoi. Managemene of the axilla in primary breast cancer[J]. Surg clin north Am, 1999, 79(5): 1061-1073.
4.	Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349(6): 546-553.
5.	Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. results of the almanac randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer[J]. Breast Cancer Res Treat, 2006, 95(3): 279-293.
6.	Julian TB, Krag DN, Brown A, et al. Preliminary technical results of NSABP B-32, a randomized phase Ⅲ clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer patients[J]. Breast Cancer Res Treat, 2004, 88(Suppl 1): S11-S12.
7.	Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10): 927-933.
8.	Cabanas RM. An approach for the treatment of penile carcinoma[J]. Cancer, 1977, 39(2): 456-466.
9.	Tan LK, Giri D, Hummer AJ, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up[J]. J Clin Oncol, 2008, 26(11): 1803-1809.
10.	Chagpar AB, Scoggins CR, Martin RC, et al. Are 3 sentinel nodes sufficient?[J]. Arch Surg, 2007, 142(5): 456-459.
11.	McCarter MD, Yeung H, Fey J, et al. The breast cancer patient with multiple sentinel nodes: when to stop?[J]. J Am Coll Surg, 2001, 192(6): 692-697.
12.	Huvos AG, Hutter RV, Berg JW. Significance of axillary macrometastases and micrometastases in mammary cancer[J]. Ann Surg, 1971, 173(1): 44-46.
13.	Greene FL, Compton CC, Shah JP, et al. AJCC. Cancer Staging Atlas[M]. New York: Springer Verlag, 2006: 219-233.
14.	Cserni G. What is a positive sentinel lymph node in a breast cancer patient? A practical approach[J]. Breast, 2007, 16(2): 152-160.
15.	Amin BD, Hoda SA. Minimal metastatic disease in sentinel lymph nodes in breast carcinoma: some modest proposals to refine criteria for “isolated tumor cells”[J]. Adv Anat Pathol, 2006, 13(4): 185-189.
16.	Singletary SE, Allred C, Ashley P, et al. Revision of the american joint committee on cancer staging system for breast cancer[J]. J Clin Oncol, 2002, 20(17): 3628-3636.
17.	Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis[J]. Cancer, 2006, 106(1): 4-16.
18.	Howard-McNatt M, Levine EA. Sentinel node mapping: status in 2008[J]. Pathol Case Rev, 2008, 13(3): 87-94.
19.	王永胜. 乳腺癌前哨淋巴结的研究进展[J]. 中国普外基础与临床杂志, 2005, 12(3): 212-215.
20.	孙秋茹, 杨小青, 于永林, 等. 蓝染脂质体载体对乳腺癌前哨及腋窝淋巴结显示的应用研究[J]. 中华肿瘤防治杂志, 2010, 17(2): 140-141.
21.	Babiera GV, Delpassand ES, Breslin TM, et al. Lymphatic drainage patterns on early versus delayed breast lymphoscintigraphy performed after injection of filtered Tc-99m sulfur colloid in breast cancer patients undergoing sentinel lymph node biopsy[J]. Clin Nucl Med, 2005, 30(1): 11-15.
22.	Nejc D, Wrzesień M, Piekarski J, et al. Sentinel node biopsy in patients with breast cancer: evaluation of exposure to radiation of medical staff[J]. Eur J Surg Oncol, 2006, 32(2): 133-138.
23.	Pogacnik A, Klopcic U, Grazio-frković S, et al. The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer[J]. Cytopathology, 2005, 16(2): 71-76.
24.	王永胜, 欧阳涛, 王启堂, 等. 中国前哨淋巴结活检多中心协作研究CBCSG-001最新资料报告[J/CD]. 中华乳腺病杂志(电子版), 2009, 3(3): 8-12.
25.	Krogerus LA, Leidenius MH, Toivonen TS, et al. Towards reasonable workload in diagnosis of sentinel lymph nodes: comparison of two frozen section methods[J]. Histopathology, 2004, 44(1): 29-34.
26.	Viale G, Mastropasqua MG, Maiorano E, et al. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving controversies on the basis of the european institute of oncology experience[J]. Virchows Arch, 2006, 448(3): 241-247.
27.	Weaver DL, Krag DN, Manna EA, et al. Detection of occult sentinel lymph node micrometastases by immunohistochemistry in breast cancer. an nsabp protocol B-32 quality assurance study[J]. Cancer, 2006, 107(4): 661-667.
28.	Choi YJ, Yun HR, Yoo KE, et al. Intraoperative examination of sentinellymph nodes by ultrarapid immunohistochemistry in breast cancer[J]. Jpn J Clin Oncol, 2006, 36(8): 489-493.
29.	Blumencranz P, Deck KB, Whitworth PW, et al. Multiple molecular assay has improved sensitivity over histological intra-operative nodal metastases tests for breast cancer patients: Results from a large multi-center trial[J]. Breast Cancer Res Treat, 2006, 100(Suppl 1): S14.
30.	Mansel RE, Goyal A, Douglas-jones A, et al. Detection of breast cancer metastasis in sentinel lymph nodes using intra-operative real time genesearch BLN assay in the operating room: results of the cardiff study[J]. Breast Cancer Res Treat, 2009, 115(3): 595-600.
31.	Veys I, Durbecq V, Majjaj S, et al. Eighteen months clinical experience with the genesearch breast lymph node assay[J]. Am J Surg, 2009, 198(2): 203-209.
32.	Tamaki Y, Akiyama F, Iwase T, et al. Molecular detection of lymph node metastases in breast cancer patients: results of a multicenter trial using the one-step nucleic acid amplification assay[J]. Clin Cancer Res, 2009, 15(8): 2879-2884.
33.	Xenidis N, Perraki M, Kafousi M, et al. Predictive and prognostic value of peripheral blood cytokeratin-19 mRNA-positive cells detected by real-time poly merase chain reaction in node-negative breast cancer patients[J]. J Clin Oncol, 2006, 24(23): 3756-3762.
34.	Watson MA, Fleming TP. Mammaglobin, a mammary-specific member of the uteroglobin gene family is overexpressed in human breast cancer[J]. Cancer Res, 1996, 56 (4): 860-865.
35.	叶春梅, 罗凤玲, 薛明兴, 等. 乳腺癌前哨淋巴结中hMAM的表达及其临床意义[J]. 中国普通外科杂志, 2010, 19(11): 1207-1210.
36.	Hughes SJ, Xi L, Raja S, et al. A rapid, fully automated, molecular-based assay accurately analyzes sentinel lymph nodes for the presence of metastatic breast cancer[J]. Ann Surg, 2006, 243(3): 389-398.
37.	Viale G, Dell’orto P, Biasi MO, et al. Comparative evaluation of an extensive histopathologic examination and a real-timereverse-transcription-polymerase chain reaction assay formammaglobin and cytokeratin 19 on axillary sentinel lymph nodes of breast carcinoma patients[J]. Ann Surg, 2008, 247(1): 136-142.
38.	McCarty KS, Silver SA. Use of PCR to evaluate axillary node status in breast cancer[J]. Pathol Case Rev, 2008, 13(3): 95-98.
39.	Wick MR. Principles of evidence-based medicine as applied to sentinel lymph node biopsies[J]. Pathol Case Rev, 2008, 13(3): 102-108.
40.	Marchetti A, Buttitta F, Bertacca G, et al. mRNA markers of breast cancer nodal metastases: comparison between mammaglobin and carcinoembryonic antigen in 248 patients[J]. J Pathol, 2001, 195(2): 186-190.
41.	Noguchi M. Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer[J]. Eur J Surg Oncol, 2008, 34(2): 129-134.
42.	Daehoon Park, Rolf Kåresen, Bjorn Naume, et al. The prognostic impact of occult nodalmetastasis in early breast carcinoma[J]. Breast Cancer Res Treat, 2009, 118(1): 57-66.
43.	Teng S, Dupont E, McCann C, et al. Do cytokeratin positive only sentinel lymph nodes warrant comp lete axillary lymph node dissection in patients with invasive breast cancer?[J]. Am Surg, 2000, 66 (6): 574-578.
44.	Langer I, Marti WR, Guller U, et al. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node(SLN)or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy[J]. Ann Surg, 2005, 241(1): 152-158.
45.	Kahn HJ, Hanna WM, Chapman JA, et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent american joint committee on cancer breast cancer staging system[J]. Breast J, 2006, 12(4): 294-301.
46.	Jörger M, Senn HJ, Thürlimann B. St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy[J]. MEMO-Magazine Eur Med Oncol, 2009, 2(4): 229-231.
47.	张嘉庆, 程琳, 郭嘉嘉. 乳腺癌外科治疗中一些争议问题的探讨[J/CD]. 中华乳腺病杂志(电子版), 2010, 4(2): 121-128.
48.	Van Rijk MC, Nieweg OE, Rutgers EJ, et al. Sentinel node biopsy before neoadjuvant chemotherapy spares breast cancer patients axillary lymph node dissection[J]. Ann Surg Oncol, 2006, 13(4): 475-479.

1. 　Kapur U, Rubinas T, Ghai R, et al. Prediction of nonsentinel lymph node metastasis in sentinel node-positive breast carcinoma[J]. Ann Diagn Pathol, 2007, 11(1): 10-12.
2. 　Benson JR, Della QG, Group MA. Management of the axilla in women with breast cancer[J]. Lancet Oncol, 2007, 8(4): 331-348.
3. 　Ismail Jatoi. Managemene of the axilla in primary breast cancer[J]. Surg clin north Am, 1999, 79(5): 1061-1073.
4. 　Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349(6): 546-553.
5. 　Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. results of the almanac randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer[J]. Breast Cancer Res Treat, 2006, 95(3): 279-293.
6. 　Julian TB, Krag DN, Brown A, et al. Preliminary technical results of NSABP B-32, a randomized phase Ⅲ clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer patients[J]. Breast Cancer Res Treat, 2004, 88(Suppl 1): S11-S12.
7. 　Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10): 927-933.
8. 　Cabanas RM. An approach for the treatment of penile carcinoma[J]. Cancer, 1977, 39(2): 456-466.
9. 　Tan LK, Giri D, Hummer AJ, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up[J]. J Clin Oncol, 2008, 26(11): 1803-1809.
10. 　Chagpar AB, Scoggins CR, Martin RC, et al. Are 3 sentinel nodes sufficient?[J]. Arch Surg, 2007, 142(5): 456-459.
11. 　McCarter MD, Yeung H, Fey J, et al. The breast cancer patient with multiple sentinel nodes: when to stop?[J]. J Am Coll Surg, 2001, 192(6): 692-697.
12. 　Huvos AG, Hutter RV, Berg JW. Significance of axillary macrometastases and micrometastases in mammary cancer[J]. Ann Surg, 1971, 173(1): 44-46.
13. 　Greene FL, Compton CC, Shah JP, et al. AJCC. Cancer Staging Atlas[M]. New York: Springer Verlag, 2006: 219-233.
14. 　Cserni G. What is a positive sentinel lymph node in a breast cancer patient? A practical approach[J]. Breast, 2007, 16(2): 152-160.
15. 　Amin BD, Hoda SA. Minimal metastatic disease in sentinel lymph nodes in breast carcinoma: some modest proposals to refine criteria for “isolated tumor cells”[J]. Adv Anat Pathol, 2006, 13(4): 185-189.
16. 　Singletary SE, Allred C, Ashley P, et al. Revision of the american joint committee on cancer staging system for breast cancer[J]. J Clin Oncol, 2002, 20(17): 3628-3636.
17. 　Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis[J]. Cancer, 2006, 106(1): 4-16.
18. 　Howard-McNatt M, Levine EA. Sentinel node mapping: status in 2008[J]. Pathol Case Rev, 2008, 13(3): 87-94.
19. 　王永胜. 乳腺癌前哨淋巴结的研究进展[J]. 中国普外基础与临床杂志, 2005, 12(3): 212-215.
20. 　孙秋茹, 杨小青, 于永林, 等. 蓝染脂质体载体对乳腺癌前哨及腋窝淋巴结显示的应用研究[J]. 中华肿瘤防治杂志, 2010, 17(2): 140-141.
21. 　Babiera GV, Delpassand ES, Breslin TM, et al. Lymphatic drainage patterns on early versus delayed breast lymphoscintigraphy performed after injection of filtered Tc-99m sulfur colloid in breast cancer patients undergoing sentinel lymph node biopsy[J]. Clin Nucl Med, 2005, 30(1): 11-15.
22. 　Nejc D, Wrzesień M, Piekarski J, et al. Sentinel node biopsy in patients with breast cancer: evaluation of exposure to radiation of medical staff[J]. Eur J Surg Oncol, 2006, 32(2): 133-138.
23. 　Pogacnik A, Klopcic U, Grazio-frković S, et al. The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer[J]. Cytopathology, 2005, 16(2): 71-76.
24. 　王永胜, 欧阳涛, 王启堂, 等. 中国前哨淋巴结活检多中心协作研究CBCSG-001最新资料报告[J/CD]. 中华乳腺病杂志(电子版), 2009, 3(3): 8-12.
25. 　Krogerus LA, Leidenius MH, Toivonen TS, et al. Towards reasonable workload in diagnosis of sentinel lymph nodes: comparison of two frozen section methods[J]. Histopathology, 2004, 44(1): 29-34.
26. 　Viale G, Mastropasqua MG, Maiorano E, et al. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving controversies on the basis of the european institute of oncology experience[J]. Virchows Arch, 2006, 448(3): 241-247.
27. 　Weaver DL, Krag DN, Manna EA, et al. Detection of occult sentinel lymph node micrometastases by immunohistochemistry in breast cancer. an nsabp protocol B-32 quality assurance study[J]. Cancer, 2006, 107(4): 661-667.
28. 　Choi YJ, Yun HR, Yoo KE, et al. Intraoperative examination of sentinellymph nodes by ultrarapid immunohistochemistry in breast cancer[J]. Jpn J Clin Oncol, 2006, 36(8): 489-493.
29. 　Blumencranz P, Deck KB, Whitworth PW, et al. Multiple molecular assay has improved sensitivity over histological intra-operative nodal metastases tests for breast cancer patients: Results from a large multi-center trial[J]. Breast Cancer Res Treat, 2006, 100(Suppl 1): S14.
30. 　Mansel RE, Goyal A, Douglas-jones A, et al. Detection of breast cancer metastasis in sentinel lymph nodes using intra-operative real time genesearch BLN assay in the operating room: results of the cardiff study[J]. Breast Cancer Res Treat, 2009, 115(3): 595-600.
31. 　Veys I, Durbecq V, Majjaj S, et al. Eighteen months clinical experience with the genesearch breast lymph node assay[J]. Am J Surg, 2009, 198(2): 203-209.
32. 　Tamaki Y, Akiyama F, Iwase T, et al. Molecular detection of lymph node metastases in breast cancer patients: results of a multicenter trial using the one-step nucleic acid amplification assay[J]. Clin Cancer Res, 2009, 15(8): 2879-2884.
33. 　Xenidis N, Perraki M, Kafousi M, et al. Predictive and prognostic value of peripheral blood cytokeratin-19 mRNA-positive cells detected by real-time poly merase chain reaction in node-negative breast cancer patients[J]. J Clin Oncol, 2006, 24(23): 3756-3762.
34. 　Watson MA, Fleming TP. Mammaglobin, a mammary-specific member of the uteroglobin gene family is overexpressed in human breast cancer[J]. Cancer Res, 1996, 56 (4): 860-865.
35. 　叶春梅, 罗凤玲, 薛明兴, 等. 乳腺癌前哨淋巴结中hMAM的表达及其临床意义[J]. 中国普通外科杂志, 2010, 19(11): 1207-1210.
36. 　Hughes SJ, Xi L, Raja S, et al. A rapid, fully automated, molecular-based assay accurately analyzes sentinel lymph nodes for the presence of metastatic breast cancer[J]. Ann Surg, 2006, 243(3): 389-398.
37. 　Viale G, Dell’orto P, Biasi MO, et al. Comparative evaluation of an extensive histopathologic examination and a real-timereverse-transcription-polymerase chain reaction assay formammaglobin and cytokeratin 19 on axillary sentinel lymph nodes of breast carcinoma patients[J]. Ann Surg, 2008, 247(1): 136-142.
38. 　McCarty KS, Silver SA. Use of PCR to evaluate axillary node status in breast cancer[J]. Pathol Case Rev, 2008, 13(3): 95-98.
39. 　Wick MR. Principles of evidence-based medicine as applied to sentinel lymph node biopsies[J]. Pathol Case Rev, 2008, 13(3): 102-108.
40. 　Marchetti A, Buttitta F, Bertacca G, et al. mRNA markers of breast cancer nodal metastases: comparison between mammaglobin and carcinoembryonic antigen in 248 patients[J]. J Pathol, 2001, 195(2): 186-190.
41. 　Noguchi M. Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer[J]. Eur J Surg Oncol, 2008, 34(2): 129-134.
42. 　Daehoon Park, Rolf Kåresen, Bjorn Naume, et al. The prognostic impact of occult nodalmetastasis in early breast carcinoma[J]. Breast Cancer Res Treat, 2009, 118(1): 57-66.
43. 　Teng S, Dupont E, McCann C, et al. Do cytokeratin positive only sentinel lymph nodes warrant comp lete axillary lymph node dissection in patients with invasive breast cancer?[J]. Am Surg, 2000, 66 (6): 574-578.
44. 　Langer I, Marti WR, Guller U, et al. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node(SLN)or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy[J]. Ann Surg, 2005, 241(1): 152-158.
45. 　Kahn HJ, Hanna WM, Chapman JA, et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent american joint committee on cancer breast cancer staging system[J]. Breast J, 2006, 12(4): 294-301.
46. 　Jörger M, Senn HJ, Thürlimann B. St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy[J]. MEMO-Magazine Eur Med Oncol, 2009, 2(4): 229-231.
47. 　张嘉庆, 程琳, 郭嘉嘉. 乳腺癌外科治疗中一些争议问题的探讨[J/CD]. 中华乳腺病杂志(电子版), 2010, 4(2): 121-128.
48. 　Van Rijk MC, Nieweg OE, Rutgers EJ, et al. Sentinel node biopsy before neoadjuvant chemotherapy spares breast cancer patients axillary lymph node dissection[J]. Ann Surg Oncol, 2006, 13(4): 475-479.

West China Medical Journal

乳腺癌前哨淋巴结微转移

Abstract Full text Figures/Tables Video References Cited by

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