ABSTRACT
Objective:This study was conducted to evaluate the roles of internal mammary sentinel lymph node biopsy (IM-SL-NB) in the treatment of breast cancer patients with clinically positive axillary lymph nodes. Methods:This study is a one-armed clini-cal research conducted from June 2013 to October 2014. A total of 64 breast cancer patients from Shandong Cancer Hospital with clini-cally positive axillary lymph nodes were enrolled in the study. All patients underwent axillary lymph node dissection. Meanwhile, IM-SLNB was performed in all patients using the new injection method of radiotracer. Results:Among the 64 enrolled patients, the visual-ization rate of internal mammary lymph node was 59.4%(38/64). For the 38 patients who were subjected to visualization of the internal mammary node, the detection rate was 100%(38/38), and the incidence of complications was 7.9%(3/38). The metastasis rate of inter-nal mammary lymph node was 21.1%(8/38). Patients with upper inner quadrant tumors and metastasis of more axillary lymph nodes had a significantly higher chance of developing sentinel lymph node metastasis (P<0.001 and P=0.017, respectively) than the other pa-tients. The clinical benefit rate of the above mentioned treatment was 59.4%. Among the patients, 12.5%(8/64) received extra internal mammary radiotherapy, whereas 46.9%(30/64) patients avoided the unnecessary internal mammary radiotherapy. Conclusion:IM-SL-NB should be performed in breast cancer patients with clinically positive axillary lymph nodes because IM-SLNB could provide the ac-curate indication of radiation to the internal mammary area, especially for the patients with upper inner quadrant tumors and those with a suspiciously high level of axillary lymph node metastasis.
ABSTRACT
ObjectiveTo evaluate the risk factors for sentinel lymph node(SLN)metastasis,and assess the value of the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram in predicting SLN metastasis in breast cancer patients.Methods A sentinel lymph node biopsy(SLNB) database containing 1227 consecutive breast cancer patients(412 patients with a positive SLN)was retrospectively analyzed.The value of MSKCC nomogram was predicted by drawing the trend line and calculating the area under the curve(AUC) of receiver-operator characteristic(ROC). Meanwhile,the risk factors of SLN metastasis were evaluated. Results Tumor size,tumor location,histological grade,lymphovascular invasion,mulifocality,ER and PR status were correlated with SLN metastasis( all P ＜ 0.05 ).All the above factors but tumor location were significant independent predictors for SLN metastasis(all P ＜ 0.01 ).The MSKCC nomogram presented AUC value of 0.730 for ROC.Patients with predictive values lower than 16％ had the frequency of 0.9％ for SLN metastasis while patients with predictive values higher than 70％ had the frequency of 96.2％.ConclusionsThe risk factors of SLN metastasis in our study are consistent with those in MSKCC nomogram.MSKCC nomogram is a useful tool in predicting the probability of SLN metastasis for breast cancer patients.Axillary surgery can be avoided in patients with the predictive values lower than 16％,axillary lymph node dissection could be done in patients with the predictive values higher than 70％,and other patients should still undergo SLNB.
