临床T1、T2 N0M0乳腺癌腋窝淋巴结转移状况研究的意义

Metastasis of axillary node in clinical T1 -T2 N0M0 breast cancer patients

目的探讨临床T1、T2 N0M0乳腺癌腋窝淋巴结转移状况及临床意义。方法结合原发肿瘤位置、年龄、病理等，分析了276例临床T1、T2 N0M0乳腺癌患者腋窝淋巴结转移情况及意义。结果临床T1 N0M0腋淋巴结转移率低于T2 N0M0乳腺癌患者（P=0．027），乳腺中央区与外下象限乳腺癌发生腋淋巴结转移明显高于其他部位肿瘤（P=0．004）；乳腺外侧象限肿瘤腋窝下组淋巴结转移率高于其他部位肿瘤组（P=0．000）；乳头中央区和内侧象限乳腺癌腋上组淋巴结转移高于乳腺外侧象限肿瘤（P=0．000）。非特殊型癌发生淋巴结转移明显高于早期癌和其他类型（P=0．001），9例单纯癌6例发生2组以上腋淋巴结转移。90例发生腋淋巴结转移的病例中，〉50岁者62例（68．9％）发生腋淋巴结转移，≤50岁者28例（31．1％）发生腋淋巴结转移（P=0．000）。发现“跳跃式”转移病例2例（0．7％），均为临床T2 N0M0患者，肿瘤位于乳头中央区1例，外下象限者1例。其中浸润型导管癌1例，单纯癌1例。结论研究临床T1、T2 N0M0乳腺癌腋窝转移淋巴结分布情况对开展SLNB及制定合理的治疗方案有一定指导价值。

Objective To study the metastasis of lymph node of breast cancer patients in clinical T1-T2 N0M0 and its clinical significance in （sentinel lymph node biopsy, SLNB）. Methods A total of 276 patients of breast cancer were enrolled in the study （T1 N0M0 cases = 115 ; T2 N0M0 cases = 161 ）. The metastasis and distribution of axillary node by virtue of the location of primary tumor, ages and pathologic status were analyzed. Results The metastasis rate of axillary node in T1 N0M0 patients was less than T2 N0M0 （ P = 0.027 ）, while that in the central and lower outer quadrant＇ s was higher than in other＇ s parts （P = 0.004 ）. When the tumor located in outer quadrant, the axillary node metastasis rate of Berg Ⅰ was highest in the central, outer and inner quadrant （P = 0. 000 ）. But the metastasis rate of Berg Ⅲ was lowest in the three quadrants （ P = 0.000）. For the pathologic status, the metastasis rate of invasive carcinoma-not otherwise specified （NOS） was higher than early breast carcinoma and other pathologic categories （ P = 0.000）. More than 2 groups axillary node metastasis was found in 6 of 9 patients with carcinoma simplex. The 90 cases with axillary node metastasis were analyzed by age. Axillary node was easier for metastasis in those cases aged above 50 years than those below 50 years （68.9% vs 31.1% ） （P = 0. 000 ）. Two cases with skip metastasis were in T2 N0M0 （invasive ductal carcinoma disease = 1, carcinoma simplex disease = 1 ）. Conclusion The distribution of the metastasis of lymph node in clinical T1 ,T2 N0M0 breast cancer plays an important role in SLNB and formulating reasonable treatment protocols.