不同分组间乳腺癌患者腋窝淋巴结转移的关联性分析

Analysis on axillary lymph node metastasis of different groups of breast cancer patients

目的：分析不同分组间乳腺癌患者淋巴结转移的情况,探讨早期乳腺癌患者中进一步缩小腋窝清扫范围的可能性。方法：选择87例未接受任何新辅助治疗的可手术乳腺癌患者,按统一标准施行乳腺癌改良根治术,均在术中行完全腋窝淋巴结清扫。所获得的样本按淋巴结分组分为Ⅰ组、Ⅱ组、Ⅲ组和Rotter’s组,分别送检病理。分析各组淋巴结转移之间的关系。结果：87例患者中,腋窝淋巴结阴性患者55例（63.2%）,阳性患者32例（36.8%）;Ⅰ组阴性患者中Rotter淋巴结转移1例,Ⅰ组淋巴结转移1~3枚24例;Ⅱ组阴性者22例（91.7%）,Rotter淋巴结转移各1例（共8.3%）;多于3枚7例,淋巴结阴性2例（28.6%）,淋巴结转移1~3枚1例（14.3%）,4~9枚3例（42.9%）,多于9枚1例（14.3%）;Ⅲ组淋巴结转移4例（57.1%）。结论：①对于无临床腋窝转移证据、术中探查未发现腋窝各组淋巴结转移的患者,理论上存在仅行Ⅰ组淋巴结清扫的可行性;②术中探查发现仅有腋窝LⅠ1~3个淋巴结转移的患者,清扫范围至少达到LⅡ;③术中探查腋窝Ⅰ组淋巴结多于3枚阳性的患者,应结合Ⅱ组转移情况考虑腋窝清扫范围,如Ⅱ组未发现转移,清扫范围应达到Ⅱ组;如Ⅱ组已经出现转移灶,应行全腋窝淋巴结清扫。

Objective To analyze the axillary lymph node metastasis of the different groups of breast cancer patients and to explore the opportunity to minimize the armpit circumscription in early stage patients.Methods 80 breast cancer patients without any neoadjuvant treatment were selected and treated with standard modified radical mastectomy and received total axillary lymph node dissection.The lymph node samples were divided into four groups such as level Ⅰ,level Ⅱ,level Ⅲ and Rotter＇s lymph node groups,then the pathologic examination was performed.Results There were 55（63.2%） patients with negative nodes and 32（36.8%） patients with positive nodes in total 87 patients.There was one patient with Rotter＇s lymph node skip metastasis in level Ⅰ negative patients.There were 24 patients with 1-3 positive nodes in level Ⅰ group, and there were 22（91.7%） patients with negative nodes in level Ⅱ group and there was one patient with positive Rotter＇s lymph node in levels Ⅰ and Ⅱ groups（8.3% together）.7 patients had more than 3 positive nodes in level Ⅰ group,there were 2（28.6%） patients with negative nodes in level Ⅱ group,one patient（14.3%） with 1-3 positive nodes,3 patients（42.9%） with 4-9 positive nodes,one patient（14.3%） with more than 9 positive nodes in level Ⅱ group and 4 patients with axillary lymph node metastasis in level Ⅲ group.Conclusion ①It exists the feasibility of giving level Ⅰ dissection to the patients with no clinical evidence of lymph node metastasis and no findings of positive nodes in the procedure of operation.②The patients with 1-3 positive nodes in level Ⅰ group should accept a at least level Ⅱ dissection.③The patients with more than 3 positive nodes should accept level Ⅱ cirumscription if there is no lymph node metastasis and should accept total armpit sirum soription if there is lymph node metastasis.