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Macrometastasis at selective lymph node biopsy:A practical goingfor-the-one clinical scoring system to personalize decision making

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World Journal of Clinical Oncology 2021年第8期12卷 675-687页

作者： Mercedes Herrero Raquel Ciérvide Maria Elisa Calle-Purón Javier Valero Paula Buelga Isabel Rodriguez-Bertos leticia benassi Angel Montero Department of Gynecology and Obstetrics HM HospitalesMadrid 28050Spain Department of Radiation Oncology HM HospitalesMadrid 28050Spain Department of Preventive Medicine and Public Health Complutense University of MadridMadrid 28050Spain

BACKGROUND Axillary sentinel lymph node biopsy(SLNB)is standard treatment for patients with clinically and pathological negative lymph ***,the role of completion axillary lymph node dissection(cALND)following positive sentinel lymph node biopsy(SLNB)is *** To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of longterm complications and create a Preoperative Clinical Risk Index(PCRI)that helps us in our clinical practice to optimize the selection of these *** Patients with positive SLNB who underwent a cALND were included in this *** and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting *** From May 2007 to April 2014,we performed 1140 SLN biopsies,of which 125 were positive for tumor and justified to practice a posterior *** findings at SLNB were micrometastases(mic)in 29 cases(23.4%)and macrometastasis(MAC)in 95 cases(76.6%).On univariate analysis of the 95 patients with MAC,statistically significant factors included:age,grade,phenotype,histology,lymphovascular invasion,lymph-node tumor size,and number of positive *** multivariate analysis,only lymph-node tumor size(≤20 mm)and number of positive SLN(>1)retained significance.A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from *** with a PCRI≤15 has low probability(*** The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit *** prospective studies are necessary to validate PCRI clinical generalization.

关键词： Sentinel lymph node biopsy Complete axillary lymph node dissection Preoperative clinical risk index Macrometastasis

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