| Xiaoyi Zhang,Rui Wang,Zhiyong Wu,Xueqing Jiang. Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method?. Oncol Transl Med, 2014, 13: 509-514. |
| 对于使用空芯针或负压辅助穿刺活检作为第一诊断方法诊断乳腺导管内原位癌的患者需要做前哨淋巴结活检 |
| Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method? |
| Received:September 12, 2014 Revised:October 26, 2014 |
| DOI：10.1007/s10330-314-0005-9 |
| 中文关键词: 导管内原位癌; 乳腺癌; 前哨淋巴结活检; 空芯针活检, 负压辅助穿刺活检 |
| 英文关键词: ductal carcinoma in situ (DCIS); breast cancer; sentinel lymph node biopsy (SLNB); core needle biopsy (CNB); vacuum-assisted biopsy (VAB) |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Xiaoyi Zhang | Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China | cloud.wind@163.com | | Rui Wang | Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China | | | Zhiyong Wu | Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China | | | Xueqing Jiang* | Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China | |
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| 中文摘要: |
| 目的: 对于乳腺癌来说腋窝淋巴结是否转移是评价患者预后和生存率的最重要的因素之一，这个对于因素在乳腺导管内原位癌尤为重要。这项研究的主要目的是探索乳腺导管内原位癌患者得到利用各种方法取得的术前病理诊断时是否需要在后续手术过程中使用前哨淋巴结活检。
方法: 通过一项回顾性研究讨论从2000年3月至2014年4月入组的124位患者，她们的术前诊断均为乳腺导管内原位癌，这些患者术中行前哨淋巴结活检和(或)腋窝淋巴结清扫，我们对患者的临床病理学特征，影像学特征及免疫组织化学结果进行分析比较。
结果: 124位患者中，82(66.1%)位确诊纯乳腺导管内原位癌，25(25.2%)位确诊乳腺导管内原位癌伴微浸润，17(13.7%)位确诊为乳腺浸润性癌。115(92.7%)位患者术中行前哨淋巴结活检，在这115位患者中，70(56.5%)位行腋窝淋巴结清扫，3(2.6%)位患者发现前哨淋巴结转移，1(1.4%)位患者发现腋窝淋巴结转移。其中84(66.7%)位患者术前使用空心针或负压辅助穿刺活检诊断， 这84位患者中26(31.0%)位患者最终病理诊断为浸润性癌。肿瘤直径较大，微钙化，粉刺型坏死，Her-2阳性，ER阴性为本组病人预测低估诊断的因素。
结论: 单纯的乳腺导管内原位癌前哨淋巴结转移的几率非常低。使用空心针或者负压辅助穿刺活检作为术前第一诊断方法诊断乳腺导管内原位时，诊断低估十分常见，本文建议，如果此患者术前诊断为乳腺导管内原位癌，合并以下临床病理学特征，如肿瘤直径较大，微钙化，粉刺型坏死，Her-2阳性，ER阴性，有很大机会在术后病检时升级为乳腺导管内原位癌或浸润性乳腺癌，这一部分患者术中应行前哨淋巴结活检。 |
| 英文摘要: |
| Objective: Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ (DCIS). The purpose of this study was to investigate whether sentinel lymph node biopsy (SLNB) should be performed in patients with an initial diagnosis of DCIS. Methods: A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results: Eighty-two patients (66.1%) had pure DCIS and 25 (20.2%) had DCIS with microinvasion (DCISM), 17 (13.7%) updated to invasive breast cancer (IBC). 115 patients (92.7%) underwent SLNB, among them, 70 patients (56.5%) underwent axillary node dissection. 3 of 115 patients (2.6%) had a positive sentinel lymph node, only 1 (1.4%) of 70 patients had axillary lymph node metastasis, in 84 patients (66.7%) who were diagnosed DCIS by core needle biopsy (CNB) and vacuum-assisted biopsy (VAB). 26 patients (31.0%) were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion: The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients. |
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