Despite advancements in breast cancer surgery, the decision-making process for axillary treatment remains complex, necessitating new predictors like the tumor size to Ki67 proliferation index ratio. Intraoperative examination of the sentinel lymph node is performed to reduce the risk of a secondary surgery. Several studies have demonstrated that even in the presence of moderate nodal involvement, local disease control can be achieved by omitting axillary lymph node dissection (ALND). The aim of our retrospective study is to compare patients subjected to sentinel lymph node biopsy (SNLB) with or without intraoperative evaluation. This study included patients with breast cancer who underwent breast-conserving surgery and SNLB. Of the 551 patients, 333 (60.4%) underwent an SNLB intraoperative evaluation (SLNB-IE), while 218 (39.6%) underwent sentinel lymph node dissection diagnostic evaluation (SLNB-DE). Our analysis revealed that the tumor size to Ki67 ratio is an independent predictive factor for axillary tumor burden, suggesting its utility in surgical decision-making. A secondary ALND was performed in 2 (0.6%) vs. 7 (2.8%),p= 0.032, and in 1 (0.4%) vs. 4 (2.1%),p= 0.171, excluding patients with T ≥ 2. Surgical time was significantly shorter (p> 0.001) in the SLNB-DE group. According to a multivariate analysis, lesion dimension (OR 1.678; 95%CI 1.019–2.145; WALD:7.588;p= 0.006) and the ratio of lesion dimension to the Ki67 proliferation index (OR 0.08; 95%CI 0.011–0.141; WALD:11.004p= 0.001) were both predictive factors for a higher axillary tumor burden. A value of 0.425, which is the ratio of tumor dimension to the Ki67 proliferation index, was identified as a predictor of tumor burden in the axilla (sensitivity, 78%; specificity, 87.5%). Intraoperative evaluation of SNLB may be omitted but could be considered in potential candidates for cyclin inhibitor and cN0 therapy with a higher ratio of tumor dimension to the Ki67 proliferation index in order to avoid secondary surgery.
尽管乳腺癌手术技术不断进步，腋窝淋巴结处理的决策过程仍较为复杂，需要引入肿瘤大小与Ki67增殖指数比值等新型预测指标。术中前哨淋巴结检查的实施旨在降低二次手术风险。多项研究表明，即使存在中度淋巴结转移，通过省略腋窝淋巴结清扫术（ALND）仍可实现局部疾病控制。本回顾性研究旨在比较接受前哨淋巴结活检（SNLB）的患者在有无术中评估情况下的临床差异。研究纳入接受保乳手术及SNLB的乳腺癌患者，在551例患者中，333例（60.4%）接受SNLB术中评估（SLNB-IE），218例（39.6%）接受前哨淋巴结切除诊断性评估（SLNB-DE）。分析显示肿瘤大小与Ki67比值是腋窝肿瘤负荷的独立预测因素，提示其在外科决策中的实用价值。二次ALND实施率分别为2例（0.6%）对比7例（2.8%）（p=0.032），排除T≥2患者后为1例（0.4%）对比4例（2.1%）（p=0.171）。SLNB-DE组手术时间显著缩短（p>0.001）。多变量分析表明，病灶尺寸（OR 1.678；95%CI 1.019–2.145；WALD:7.588；p=0.006）及病灶尺寸与Ki67增殖指数比值（OR 0.08；95%CI 0.011–0.141；WALD:11.004；p=0.001）均为较高腋窝肿瘤负荷的预测因素。肿瘤尺寸与Ki67增殖指数比值0.425被确定为腋窝肿瘤负荷的预测阈值（敏感性78%，特异性87.5%）。对于肿瘤尺寸与Ki67增殖指数比值较高的周期蛋白抑制剂治疗候选者及cN0患者，可考虑实施SNLB术中评估以避免二次手术，但该评估并非必需程序。
肿瘤(癌症)患者之家