We examined clinically node-positive (cN+) breast cancer patients undergoing neoadjuvant chemotherapy and clipped lymph node (CLN) localization to determine the rate of CLN = non-sentinel lymph node (SLN), the factors associated with cN+ to pN0 conversion, and the treatment impact. We conducted a single institution review of cN+ patients receiving NAC from 2016 to 2022 with preoperative CLN localization (N = 81). Demographics, hormone receptor (HR) and HER2 status, time to surgery, staging, chemotherapy regimen, localization method, pathology, and adjuvant therapy were analyzed. Pathologic complete response (pCR) of the CLN was observed in 41 patients (50.6%): 18.8% HR+/HER2−, 75% HR+/HER2+, 75% HR−/HER2+, and 62.5% triple-negative breast cancer (p-value = 0.006). CLN = SLN in 68 (84%) patients, while CLN = non-SLN in 13 (16%). In 14 (17.3%) patients, the final treatment was altered based on +CLN status: 11 patients underwent axillary lymph node dissection (ALND), and 3 had systemic treatment changes. pCR rates varied, with the highest conversion rates observed in HER2+ disease and the lowest in HR+/HER2− disease. In 2 (2.5%) patients, adjuvant therapy changes were made based on a non-sentinel CLN, while in 97.5% of patients, a SLN biopsy alone represented the status of the axilla. This demonstrates that a +CLN often alters final plans and that, despite also being a SLN in most cases, a subset of patients will be undertreated by SLN biopsy alone.
本研究对接受新辅助化疗及标记淋巴结定位的临床淋巴结阳性乳腺癌患者进行分析，旨在探究标记淋巴结与非前哨淋巴结的对应率、影响临床淋巴结阳性向病理淋巴结阴性转化的相关因素及其对治疗方案的影响。我们对2016年至2022年间于单一机构接受新辅助化疗并行术前标记淋巴结定位的81例临床淋巴结阳性患者进行回顾性分析，收集并分析了人口统计学特征、激素受体与HER2状态、手术间隔时间、分期、化疗方案、定位方法、病理结果及辅助治疗等数据。 结果显示，41例患者（50.6%）的标记淋巴结达到病理完全缓解，其中激素受体阳性/HER2阴性型占18.8%，激素受体阳性/HER2阳性型占75%，激素受体阴性/HER2阳性型占75%，三阴性乳腺癌占62.5%（p值=0.006）。在68例患者（84%）中标记淋巴结即为前哨淋巴结，而13例患者（16%）中标记淋巴结为非前哨淋巴结。基于标记淋巴结阳性状态，14例患者（17.3%）的最终治疗方案发生调整：其中11例接受腋窝淋巴结清扫术，3例更改全身治疗方案。 病理完全缓解率在不同亚型中存在差异，HER2阳性型疾病转化率最高，而激素受体阳性/HER2阴性型转化率最低。在2例患者（2.5%）中，辅助治疗方案因标记淋巴结为非前哨淋巴结而调整；而在97.5%的患者中，仅通过前哨淋巴结活检即可反映腋窝淋巴结状态。研究表明，标记淋巴结阳性状态常导致最终治疗方案的改变，且尽管在多数情况下标记淋巴结同时为前哨淋巴结，仅进行前哨淋巴结活检可能导致部分患者治疗不足。
Retrieval of the Clipped Axillary Lymph Node and Its Impact on Treatment Decisions
肿瘤(癌症)患者之家