Predictive factors of lymph node metastasis and effectiveness of intraoperative examination of sentinel lymph node in breast carcinoma: A retrospective Belgian study

被引:1
|
作者
Catteau, Xavier [1 ,2 ]
Koopmansch, Caroline [2 ]
Maris, Calliope [1 ,2 ]
Colart, Patrick [3 ]
Noel, Jean-Christophe [2 ]
机构
[1] CHU Tivoli La Louviere, CUREPATH Chirec Inst Brussels, Rue Borfilet 12A, B-6040 Jumet, Belgium
[2] Univ Libre Bruxelles, Erasme Univ Hosp, Pathol Dept, CP 610,Route Lenn 808, B-1070 Brussels, Belgium
[3] Braine L Alleud Waterloo Hosp, Gynaecol Dept, Rue Wayez 35, B-1420 Braine Lalleud Waterloo, Belgium
关键词
Sentinel lymph nodes; Breast carcinoma; Intraoperative examination; Metastasis; Belgium; FROZEN-SECTION DIAGNOSIS; CANCER AMERICAN SOCIETY; GROUP Z0011 TRIAL; AXILLARY DISSECTION; COLLEGE; BIOPSY; SURGERY; IMPACT; WOMEN;
D O I
10.1016/j.anndiagpath.2020.151607
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Recently, several trials demonstrated the safety of omitting axillary lymph node dissection in clinically NO patients with positive sentinel nodes in select subgroups. However, this fact is still troublesome to clarify to surgeons and clinicians, as they used to perform intraoperative examination of the sentinel node and axillary dissection for many years. Hence, we decided to review our practice. This is to firstly highlight the predictive factors of node metastasis and secondly, to evaluate the effectiveness of intraoperative examination of the sentinel node. There were 406 total procedures. The rate of positive lymph nodes in the final diagnosis was 27%. Factors associated with metastasis were age, tumour size, TNM classification, tumour grade, vascular invasion, molecular classification and KI-67 index. The rate of reoperation was 6.2% in cases with final positive nodes, however, the complementary ALND was justified in only 2.7%. Forty-nine percent of SLN were examined during surgery (IOESLN), whereby the false negative rate was 11.8%. Sixty-three intraoperative examinations were necessary to prevent a second operation on a patient. We recommend changing the clinical management of the axilla, resulting in fewer ALNDs in selected cNO, SLN-positive patients. In keeping with recent large clinical trial (ACOSOG Z0011, AMAROS and OTOASOR) data, our results support that intraoperative exam in selected cNO, SLN-positive Belgian patients is no longer effective.
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页数:6
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