• 1 第三軍醫(yī)大學第三附屬醫(yī)院野戰(zhàn)外科研究所乳腺甲狀腺血管外科（重慶，400042）;2 四川大學華西醫(yī)院甲狀腺乳腺外科;

【摘要】　 乳腺癌是女性最常見的惡性腫瘤之一，腋窩淋巴結的轉移狀況是乳腺癌患者最有價值的預后因素。乳腺癌前哨淋巴結活檢術的開展有望替代腋窩淋巴結清掃術，從而減少甚至避免腋窩淋巴結清掃帶來的疼痛、麻木、水腫、運動障礙等并發(fā)癥。常規(guī)病理技術無法確定存在于淋巴結的微轉移灶，而這些微轉移灶對乳腺癌的診斷、分期復發(fā)與預后判斷、綜合治療的選擇具有極其明顯的意義。較高的假陰性率是前哨淋巴結活檢的不利因素，不僅導致分期不準確，更重要的是影響了患者最佳治療方案的制定。對前哨淋巴結微轉移的檢測可以提高分期的準確性，改變一部分患者的治療決策。現就乳腺癌前哨淋巴結微轉移的相關情況做一綜述。

引用本文： 姜燕,李宏江. 乳腺癌前哨淋巴結微轉移. 華西醫(yī)學, 2011, 26(7): 995-999. doi: 復制

1. 　Kapur U, Rubinas T, Ghai R, et al. Prediction of nonsentinel lymph node metastasis in sentinel node-positive breast carcinoma[J]. Ann Diagn Pathol, 2007, 11(1): 10-12.
2. 　Benson JR, Della QG, Group MA. Management of the axilla in women with breast cancer[J]. Lancet Oncol, 2007, 8(4): 331-348.
3. 　Ismail Jatoi. Managemene of the axilla in primary breast cancer[J]. Surg clin north Am, 1999, 79(5): 1061-1073.
4. 　Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349(6): 546-553.
5. 　Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. results of the almanac randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer[J]. Breast Cancer Res Treat, 2006, 95(3): 279-293.
6. 　Julian TB, Krag DN, Brown A, et al. Preliminary technical results of NSABP B-32, a randomized phase Ⅲ clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer patients[J]. Breast Cancer Res Treat, 2004, 88(Suppl 1): S11-S12.
7. 　Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10): 927-933.
8. 　Cabanas RM. An approach for the treatment of penile carcinoma[J]. Cancer, 1977, 39(2): 456-466.
9. 　Tan LK, Giri D, Hummer AJ, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up[J]. J Clin Oncol, 2008, 26(11): 1803-1809.
10. 　Chagpar AB, Scoggins CR, Martin RC, et al. Are 3 sentinel nodes sufficient?[J]. Arch Surg, 2007, 142(5): 456-459.
11. 　McCarter MD, Yeung H, Fey J, et al. The breast cancer patient with multiple sentinel nodes: when to stop?[J]. J Am Coll Surg, 2001, 192(6): 692-697.
12. 　Huvos AG, Hutter RV, Berg JW. Significance of axillary macrometastases and micrometastases in mammary cancer[J]. Ann Surg, 1971, 173(1): 44-46.
13. 　Greene FL, Compton CC, Shah JP, et al. AJCC. Cancer Staging Atlas[M]. New York: Springer Verlag, 2006: 219-233.
14. 　Cserni G. What is a positive sentinel lymph node in a breast cancer patient? A practical approach[J]. Breast, 2007, 16(2): 152-160.
15. 　Amin BD, Hoda SA. Minimal metastatic disease in sentinel lymph nodes in breast carcinoma: some modest proposals to refine criteria for “isolated tumor cells”[J]. Adv Anat Pathol, 2006, 13(4): 185-189.
16. 　Singletary SE, Allred C, Ashley P, et al. Revision of the american joint committee on cancer staging system for breast cancer[J]. J Clin Oncol, 2002, 20(17): 3628-3636.
17. 　Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis[J]. Cancer, 2006, 106(1): 4-16.
18. 　Howard-McNatt M, Levine EA. Sentinel node mapping: status in 2008[J]. Pathol Case Rev, 2008, 13(3): 87-94.
19. 　王永勝. 乳腺癌前哨淋巴結的研究進展[J]. 中國普外基礎與臨床雜志, 2005, 12(3): 212-215.
20. 　孫秋茹, 楊小青, 于永林, 等. 藍染脂質體載體對乳腺癌前哨及腋窩淋巴結顯示的應用研究[J]. 中華腫瘤防治雜志, 2010, 17(2): 140-141.
21. 　Babiera GV, Delpassand ES, Breslin TM, et al. Lymphatic drainage patterns on early versus delayed breast lymphoscintigraphy performed after injection of filtered Tc-99m sulfur colloid in breast cancer patients undergoing sentinel lymph node biopsy[J]. Clin Nucl Med, 2005, 30(1): 11-15.
22. 　Nejc D, Wrzesień M, Piekarski J, et al. Sentinel node biopsy in patients with breast cancer: evaluation of exposure to radiation of medical staff[J]. Eur J Surg Oncol, 2006, 32(2): 133-138.
23. 　Pogacnik A, Klopcic U, Grazio-frkovi? S, et al. The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer[J]. Cytopathology, 2005, 16(2): 71-76.
24. 　王永勝, 歐陽濤, 王啟堂, 等. 中國前哨淋巴結活檢多中心協作研究CBCSG-001最新資料報告[J/CD]. 中華乳腺病雜志(電子版), 2009, 3(3): 8-12.
25. 　Krogerus LA, Leidenius MH, Toivonen TS, et al. Towards reasonable workload in diagnosis of sentinel lymph nodes: comparison of two frozen section methods[J]. Histopathology, 2004, 44(1): 29-34.
26. 　Viale G, Mastropasqua MG, Maiorano E, et al. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving controversies on the basis of the european institute of oncology experience[J]. Virchows Arch, 2006, 448(3): 241-247.
27. 　Weaver DL, Krag DN, Manna EA, et al. Detection of occult sentinel lymph node micrometastases by immunohistochemistry in breast cancer. an nsabp protocol B-32 quality assurance study[J]. Cancer, 2006, 107(4): 661-667.
28. 　Choi YJ, Yun HR, Yoo KE, et al. Intraoperative examination of sentinellymph nodes by ultrarapid immunohistochemistry in breast cancer[J]. Jpn J Clin Oncol, 2006, 36(8): 489-493.
29. 　Blumencranz P, Deck KB, Whitworth PW, et al. Multiple molecular assay has improved sensitivity over histological intra-operative nodal metastases tests for breast cancer patients: Results from a large multi-center trial[J]. Breast Cancer Res Treat, 2006, 100(Suppl 1): S14.
30. 　Mansel RE, Goyal A, Douglas-jones A, et al. Detection of breast cancer metastasis in sentinel lymph nodes using intra-operative real time genesearch BLN assay in the operating room: results of the cardiff study[J]. Breast Cancer Res Treat, 2009, 115(3): 595-600.
31. 　Veys I, Durbecq V, Majjaj S, et al. Eighteen months clinical experience with the genesearch breast lymph node assay[J]. Am J Surg, 2009, 198(2): 203-209.
32. 　Tamaki Y, Akiyama F, Iwase T, et al. Molecular detection of lymph node metastases in breast cancer patients: results of a multicenter trial using the one-step nucleic acid amplification assay[J]. Clin Cancer Res, 2009, 15(8): 2879-2884.
33. 　Xenidis N, Perraki M, Kafousi M, et al. Predictive and prognostic value of peripheral blood cytokeratin-19 mRNA-positive cells detected by real-time poly merase chain reaction in node-negative breast cancer patients[J]. J Clin Oncol, 2006, 24(23): 3756-3762.
34. 　Watson MA, Fleming TP. Mammaglobin, a mammary-specific member of the uteroglobin gene family is overexpressed in human breast cancer[J]. Cancer Res, 1996, 56 (4): 860-865.
35. 　葉春梅, 羅鳳玲, 薛明興, 等. 乳腺癌前哨淋巴結中hMAM的表達及其臨床意義[J]. 中國普通外科雜志, 2010, 19(11): 1207-1210.
36. 　Hughes SJ, Xi L, Raja S, et al. A rapid, fully automated, molecular-based assay accurately analyzes sentinel lymph nodes for the presence of metastatic breast cancer[J]. Ann Surg, 2006, 243(3): 389-398.
37. 　Viale G, Dell’orto P, Biasi MO, et al. Comparative evaluation of an extensive histopathologic examination and a real-timereverse-transcription-polymerase chain reaction assay formammaglobin and cytokeratin 19 on axillary sentinel lymph nodes of breast carcinoma patients[J]. Ann Surg, 2008, 247(1): 136-142.
38. 　McCarty KS, Silver SA. Use of PCR to evaluate axillary node status in breast cancer[J]. Pathol Case Rev, 2008, 13(3): 95-98.
39. 　Wick MR. Principles of evidence-based medicine as applied to sentinel lymph node biopsies[J]. Pathol Case Rev, 2008, 13(3): 102-108.
40. 　Marchetti A, Buttitta F, Bertacca G, et al. mRNA markers of breast cancer nodal metastases: comparison between mammaglobin and carcinoembryonic antigen in 248 patients[J]. J Pathol, 2001, 195(2): 186-190.
41. 　Noguchi M. Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer[J]. Eur J Surg Oncol, 2008, 34(2): 129-134.
42. 　Daehoon Park, Rolf Kåresen, Bjorn Naume, et al. The prognostic impact of occult nodalmetastasis in early breast carcinoma[J]. Breast Cancer Res Treat, 2009, 118(1): 57-66.
43. 　Teng S, Dupont E, McCann C, et al. Do cytokeratin positive only sentinel lymph nodes warrant comp lete axillary lymph node dissection in patients with invasive breast cancer?[J]. Am Surg, 2000, 66 (6): 574-578.
44. 　Langer I, Marti WR, Guller U, et al. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node(SLN)or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy[J]. Ann Surg, 2005, 241(1): 152-158.
45. 　Kahn HJ, Hanna WM, Chapman JA, et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent american joint committee on cancer breast cancer staging system[J]. Breast J, 2006, 12(4): 294-301.
46. 　Jörger M, Senn HJ, Thürlimann B. St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy[J]. MEMO-Magazine Eur Med Oncol, 2009, 2(4): 229-231.
47. 　張嘉慶, 程琳, 郭嘉嘉. 乳腺癌外科治療中一些爭議問題的探討[J/CD]. 中華乳腺病雜志(電子版), 2010, 4(2): 121-128.
48. 　Van Rijk MC, Nieweg OE, Rutgers EJ, et al. Sentinel node biopsy before neoadjuvant chemotherapy spares breast cancer patients axillary lymph node dissection[J]. Ann Surg Oncol, 2006, 13(4): 475-479.
  1. 1. 　Kapur U, Rubinas T, Ghai R, et al. Prediction of nonsentinel lymph node metastasis in sentinel node-positive breast carcinoma[J]. Ann Diagn Pathol, 2007, 11(1): 10-12.
  2. 2. 　Benson JR, Della QG, Group MA. Management of the axilla in women with breast cancer[J]. Lancet Oncol, 2007, 8(4): 331-348.
  3. 3. 　Ismail Jatoi. Managemene of the axilla in primary breast cancer[J]. Surg clin north Am, 1999, 79(5): 1061-1073.
  4. 4. 　Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349(6): 546-553.
  5. 5. 　Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. results of the almanac randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer[J]. Breast Cancer Res Treat, 2006, 95(3): 279-293.
  6. 6. 　Julian TB, Krag DN, Brown A, et al. Preliminary technical results of NSABP B-32, a randomized phase Ⅲ clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer patients[J]. Breast Cancer Res Treat, 2004, 88(Suppl 1): S11-S12.
  7. 7. 　Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10): 927-933.
  8. 8. 　Cabanas RM. An approach for the treatment of penile carcinoma[J]. Cancer, 1977, 39(2): 456-466.
  9. 9. 　Tan LK, Giri D, Hummer AJ, et al. Occult axillary node metastases in breast cancer are prognostically significant: results in 368 node-negative patients with 20-year follow-up[J]. J Clin Oncol, 2008, 26(11): 1803-1809.
  10. 10. 　Chagpar AB, Scoggins CR, Martin RC, et al. Are 3 sentinel nodes sufficient?[J]. Arch Surg, 2007, 142(5): 456-459.
  11. 11. 　McCarter MD, Yeung H, Fey J, et al. The breast cancer patient with multiple sentinel nodes: when to stop?[J]. J Am Coll Surg, 2001, 192(6): 692-697.
  12. 12. 　Huvos AG, Hutter RV, Berg JW. Significance of axillary macrometastases and micrometastases in mammary cancer[J]. Ann Surg, 1971, 173(1): 44-46.
  13. 13. 　Greene FL, Compton CC, Shah JP, et al. AJCC. Cancer Staging Atlas[M]. New York: Springer Verlag, 2006: 219-233.
  14. 14. 　Cserni G. What is a positive sentinel lymph node in a breast cancer patient? A practical approach[J]. Breast, 2007, 16(2): 152-160.
  15. 15. 　Amin BD, Hoda SA. Minimal metastatic disease in sentinel lymph nodes in breast carcinoma: some modest proposals to refine criteria for “isolated tumor cells”[J]. Adv Anat Pathol, 2006, 13(4): 185-189.
  16. 16. 　Singletary SE, Allred C, Ashley P, et al. Revision of the american joint committee on cancer staging system for breast cancer[J]. J Clin Oncol, 2002, 20(17): 3628-3636.
  17. 17. 　Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis[J]. Cancer, 2006, 106(1): 4-16.
  18. 18. 　Howard-McNatt M, Levine EA. Sentinel node mapping: status in 2008[J]. Pathol Case Rev, 2008, 13(3): 87-94.
  19. 19. 　王永勝. 乳腺癌前哨淋巴結的研究進展[J]. 中國普外基礎與臨床雜志, 2005, 12(3): 212-215.
  20. 20. 　孫秋茹, 楊小青, 于永林, 等. 藍染脂質體載體對乳腺癌前哨及腋窩淋巴結顯示的應用研究[J]. 中華腫瘤防治雜志, 2010, 17(2): 140-141.
  21. 21. 　Babiera GV, Delpassand ES, Breslin TM, et al. Lymphatic drainage patterns on early versus delayed breast lymphoscintigraphy performed after injection of filtered Tc-99m sulfur colloid in breast cancer patients undergoing sentinel lymph node biopsy[J]. Clin Nucl Med, 2005, 30(1): 11-15.
  22. 22. 　Nejc D, Wrzesień M, Piekarski J, et al. Sentinel node biopsy in patients with breast cancer: evaluation of exposure to radiation of medical staff[J]. Eur J Surg Oncol, 2006, 32(2): 133-138.
  23. 23. 　Pogacnik A, Klopcic U, Grazio-frkovi? S, et al. The reliability and accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer[J]. Cytopathology, 2005, 16(2): 71-76.
  24. 24. 　王永勝, 歐陽濤, 王啟堂, 等. 中國前哨淋巴結活檢多中心協作研究CBCSG-001最新資料報告[J/CD]. 中華乳腺病雜志(電子版), 2009, 3(3): 8-12.
  25. 25. 　Krogerus LA, Leidenius MH, Toivonen TS, et al. Towards reasonable workload in diagnosis of sentinel lymph nodes: comparison of two frozen section methods[J]. Histopathology, 2004, 44(1): 29-34.
  26. 26. 　Viale G, Mastropasqua MG, Maiorano E, et al. Pathologic examination of the axillary sentinel lymph nodes in patients with early-stage breast carcinoma: current and resolving controversies on the basis of the european institute of oncology experience[J]. Virchows Arch, 2006, 448(3): 241-247.
  27. 27. 　Weaver DL, Krag DN, Manna EA, et al. Detection of occult sentinel lymph node micrometastases by immunohistochemistry in breast cancer. an nsabp protocol B-32 quality assurance study[J]. Cancer, 2006, 107(4): 661-667.
  28. 28. 　Choi YJ, Yun HR, Yoo KE, et al. Intraoperative examination of sentinellymph nodes by ultrarapid immunohistochemistry in breast cancer[J]. Jpn J Clin Oncol, 2006, 36(8): 489-493.
  29. 29. 　Blumencranz P, Deck KB, Whitworth PW, et al. Multiple molecular assay has improved sensitivity over histological intra-operative nodal metastases tests for breast cancer patients: Results from a large multi-center trial[J]. Breast Cancer Res Treat, 2006, 100(Suppl 1): S14.
  30. 30. 　Mansel RE, Goyal A, Douglas-jones A, et al. Detection of breast cancer metastasis in sentinel lymph nodes using intra-operative real time genesearch BLN assay in the operating room: results of the cardiff study[J]. Breast Cancer Res Treat, 2009, 115(3): 595-600.
  31. 31. 　Veys I, Durbecq V, Majjaj S, et al. Eighteen months clinical experience with the genesearch breast lymph node assay[J]. Am J Surg, 2009, 198(2): 203-209.
  32. 32. 　Tamaki Y, Akiyama F, Iwase T, et al. Molecular detection of lymph node metastases in breast cancer patients: results of a multicenter trial using the one-step nucleic acid amplification assay[J]. Clin Cancer Res, 2009, 15(8): 2879-2884.
  33. 33. 　Xenidis N, Perraki M, Kafousi M, et al. Predictive and prognostic value of peripheral blood cytokeratin-19 mRNA-positive cells detected by real-time poly merase chain reaction in node-negative breast cancer patients[J]. J Clin Oncol, 2006, 24(23): 3756-3762.
  34. 34. 　Watson MA, Fleming TP. Mammaglobin, a mammary-specific member of the uteroglobin gene family is overexpressed in human breast cancer[J]. Cancer Res, 1996, 56 (4): 860-865.
  35. 35. 　葉春梅, 羅鳳玲, 薛明興, 等. 乳腺癌前哨淋巴結中hMAM的表達及其臨床意義[J]. 中國普通外科雜志, 2010, 19(11): 1207-1210.
  36. 36. 　Hughes SJ, Xi L, Raja S, et al. A rapid, fully automated, molecular-based assay accurately analyzes sentinel lymph nodes for the presence of metastatic breast cancer[J]. Ann Surg, 2006, 243(3): 389-398.
  37. 37. 　Viale G, Dell’orto P, Biasi MO, et al. Comparative evaluation of an extensive histopathologic examination and a real-timereverse-transcription-polymerase chain reaction assay formammaglobin and cytokeratin 19 on axillary sentinel lymph nodes of breast carcinoma patients[J]. Ann Surg, 2008, 247(1): 136-142.
  38. 38. 　McCarty KS, Silver SA. Use of PCR to evaluate axillary node status in breast cancer[J]. Pathol Case Rev, 2008, 13(3): 95-98.
  39. 39. 　Wick MR. Principles of evidence-based medicine as applied to sentinel lymph node biopsies[J]. Pathol Case Rev, 2008, 13(3): 102-108.
  40. 40. 　Marchetti A, Buttitta F, Bertacca G, et al. mRNA markers of breast cancer nodal metastases: comparison between mammaglobin and carcinoembryonic antigen in 248 patients[J]. J Pathol, 2001, 195(2): 186-190.
  41. 41. 　Noguchi M. Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer[J]. Eur J Surg Oncol, 2008, 34(2): 129-134.
  42. 42. 　Daehoon Park, Rolf Kåresen, Bjorn Naume, et al. The prognostic impact of occult nodalmetastasis in early breast carcinoma[J]. Breast Cancer Res Treat, 2009, 118(1): 57-66.
  43. 43. 　Teng S, Dupont E, McCann C, et al. Do cytokeratin positive only sentinel lymph nodes warrant comp lete axillary lymph node dissection in patients with invasive breast cancer?[J]. Am Surg, 2000, 66 (6): 574-578.
  44. 44. 　Langer I, Marti WR, Guller U, et al. Axillary recurrence rate in breast cancer patients with negative sentinel lymph node(SLN)or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy[J]. Ann Surg, 2005, 241(1): 152-158.
  45. 45. 　Kahn HJ, Hanna WM, Chapman JA, et al. Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent american joint committee on cancer breast cancer staging system[J]. Breast J, 2006, 12(4): 294-301.
  46. 46. 　Jörger M, Senn HJ, Thürlimann B. St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy[J]. MEMO-Magazine Eur Med Oncol, 2009, 2(4): 229-231.
  47. 47. 　張嘉慶, 程琳, 郭嘉嘉. 乳腺癌外科治療中一些爭議問題的探討[J/CD]. 中華乳腺病雜志(電子版), 2010, 4(2): 121-128.
  48. 48. 　Van Rijk MC, Nieweg OE, Rutgers EJ, et al. Sentinel node biopsy before neoadjuvant chemotherapy spares breast cancer patients axillary lymph node dissection[J]. Ann Surg Oncol, 2006, 13(4): 475-479.