감시림프절이 양성인 유방암 환자에서 액와부 비감시림프절 전이의 예측 인자 (Predictors of Non-sentinel Lymph Node Metastasis in Breast Cancer)

서지정보

· 발행기관 : 한국유방암학회
· 수록지 정보 : Journal of Breast Cancer / 10권 / 1호 / 95 ~ 100페이지
· 저자명 : 김양희, 김민석, 백남선, 문난모, 노우철

초록

Purpose: Sentinel lymph node (SLN) biopsy has been shown to be accurate in axillary node staging in early breast cancer. If any SLN is positive, the standard care remains completion axillary node dissection (ALND). However over 50% of the patients with metastatic SLNs do not show other non-SLN
metastasis. The purpose of this study was to identify predictors of non-SLN tumor involvement in patients with metastatic SLNs. Methods: We reviewed 387 breast cancer patients in whom an SLN biopsy was successfully performed using a subareolar injection of 99mTc-Tin colloid. Results: Among the reviewed patients, 83 patients showed positive SLNs, and subsequently underwent ALND. In 47 of 83 patients (56.6%), SLNs were the only metastatic nodes. The following factors were assessed for predictors of non-SLN metastasis: age of the patient, size, grade, histologic type, multicentricity of the primary tumor, number of SLNs removed, number of positive SLNs, number of negative SLNs, size of the SLN metastasis, percentage of SLNs replaced
by metastasis, and extracapsular extension (ECE). By multi-variate analysis, the size of SLN metastasis (<2 mm), absence of ECE, and the percent replacement (10%) were negative predictors of non-SLN metastasis. Among 18 cases in which micrometastasis were found in the SLNs, additional metastasis in non-SLN has been found in 3 cases. This result suggests that micro-metastasis in a SLN is not a sufficient condition for not performing ALND. However, in 9 cases, in which all of three factors (micrometastasis, absence of ECE, no more than 10% replacement of SLNs by tumor cells) were
present, additional metastasis had not been found in the non-SLNs. Conclusion: Although further study is needed to verify the result, it would seem that the presence of all three factors (micrometastasis, absence of ECE, no more than 10% replacement of SLNs by tumor cells) in combination might be sufficient to safely omit ALND.

영어초록

Purpose: Sentinel lymph node (SLN) biopsy has been shown to be accurate in axillary node staging in early breast cancer. If any SLN is positive, the standard care remains completion axillary node dissection (ALND). However over 50% of the patients with metastatic SLNs do not show other non-SLN
metastasis. The purpose of this study was to identify predictors of non-SLN tumor involvement in patients with metastatic SLNs. Methods: We reviewed 387 breast cancer patients in whom an SLN biopsy was successfully performed using a subareolar injection of 99mTc-Tin colloid. Results: Among the reviewed patients, 83 patients showed positive SLNs, and subsequently underwent ALND. In 47 of 83 patients (56.6%), SLNs were the only metastatic nodes. The following factors were assessed for predictors of non-SLN metastasis: age of the patient, size, grade, histologic type, multicentricity of the primary tumor, number of SLNs removed, number of positive SLNs, number of negative SLNs, size of the SLN metastasis, percentage of SLNs replaced
by metastasis, and extracapsular extension (ECE). By multi-variate analysis, the size of SLN metastasis (<2 mm), absence of ECE, and the percent replacement (10%) were negative predictors of non-SLN metastasis. Among 18 cases in which micrometastasis were found in the SLNs, additional metastasis in non-SLN has been found in 3 cases. This result suggests that micro-metastasis in a SLN is not a sufficient condition for not performing ALND. However, in 9 cases, in which all of three factors (micrometastasis, absence of ECE, no more than 10% replacement of SLNs by tumor cells) were
present, additional metastasis had not been found in the non-SLNs. Conclusion: Although further study is needed to verify the result, it would seem that the presence of all three factors (micrometastasis, absence of ECE, no more than 10% replacement of SLNs by tumor cells) in combination might be sufficient to safely omit ALND.

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