Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement

摘要

Background: Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. Aims: To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. Study design: Retrospective clinical study. Methods: In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. Results: Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%). The incidence of larger tumour size (2.543±1.21 vs. 1.974±1.04), lymphatic vessel invasion (70.6% vs. 29.4%), blood vessel invasion (84.2% vs. 15.8%), and invasive lobular carcinoma subtype (72.7% vs. 27.3%) were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021) and lymphatic vessel invasion (odds ratio: 4.68, p=0.001) as significant primary tumour-related prognostic determinants of SLN metastasis. Conclusion: A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice. Turkish Ba?l?k:Meme Kanserinde Bek?i Lenf Nodu Biyopsisi; Aksiller ve Bek?i D??? Lenf Nodu Tutulumunun Belirleyicileri Anahtar Kelimeler:Meme neoplazmlar?, lenfatik metastaz, bek?i lenf nodu biyopsisi Arkaplan: Bek?i lenf nodu biopsisi (BLNB), T1-2N0M0 meme kanserli hastalarda aksilla durumunun de?erlendirmesi i?in standart bir y?ntemdir. Ama?: BLNB yap?lan hastalarda, aksiller ve bek?i d??? lenf nodu tutulumu üzerinde birincil tüm?r ile ilgili klinik-histopatolojik fakt?rlerin prognostik ?nemini belirlemektir. ?al??ma Tasar?m?: Geriye d?nük (retrospektif) klinik ?al??ma Y?ntemler: Bu ?al??mada, Haziran 2008 ve Aral?k 2011 tarihleri aras?nda erken evre meme kanseri olan ard???k 151 hastaya 157 BLNB uyguland?. Bulgular: Yüz elli sekiz prosedürün 157'sinde ba?ar?l? lenfatik haritalama elde edildi. BLN tutulumu olan hastalarda büyük tüm?r boyutu (2.543±1.21'e kar?? 1.974±1.04), lenf damar invazyonu (LD?) (%70.6'e kar?? %29.4), kan damar invazyonu (KD?) (%84.2'e kar?? %15.8) ve invaziv lobüler karsinom alt tipi (%72.7'e kar?? %27.3) istatistiksel olarak anlaml? derecede yüksek bulundu. Lojistik a?amal? regresyon analizinde, birincil tüm?r ile ilgilibu d?rt prognostik belirleyicilerden LD? (Odds Ratio: 4.68, p=0.001) ve tüm?r boyutu (Odds Ratio: 1.51, p=0.0021) BLN metastaz? üzerinde en belirgin etkiye sahipti. Sonu?: Tüm?r boyutu ve birincil tüm?rün lenf damar invazyonu ile aksiller lenf nodu tutulumu aras?nda yak?n bir ili?ki tespit edilmi?tir. Ancak bu iki ba??ms?z de?i?kenin pozitif ?ng?rü de?eri dü?ük olup rutin klinik uygulamada kullan?m?n? ?nermek i?in hi?bir zorlay?c? kan?t mevcut de?ildir.