감시림프절 전이 양성인 유방암 환자의 비감시림프절 전이 예측을 위한 감시림프절 감마선량의 유용성

• Published in: Annals of surgical treatment and research Vol. 70; no. 5; pp. 341 - 348
• Main Authors: 이동희(Dong Hee Lee), 김범석(Bum Seok Kim), 강수환(Su Hwan Kang), 이남혁(Nam Hyuk Lee), 이수정(Soo Jung Lee), 배영경(Young Kyung Bae)
• Format: Journal Article
• Language: Korean
• Published: 대한외과학회 01.05.2006
• Subjects: 일반외과학; 유방암; Nonsentinel lymph node; Breast cancer; 비감시림프절; Sentinel lymph node; 감시림프절
• ISSN: 2288-6575; 2288-6796

Purpose: The goal of this study was to identify a patient subgroup with a positive SLN where exposure to the morbidity and cost associated of an axillary lymph node dissection (ALND) is not required. To achieve this goal, we subdivided SLNs according to their isotope counts, and then assessed whether the number of positive SLNs and subdivided status were related to the axillary NSLN status. Methods: During SLN biopsies, the ex vivo isotope counts were measured for each SLN. Each SLN was labeled as S1, S2 or S3, and so on, in descending count order. An SLN biopsy was performed until the isotope counts of the axilla equaled that of the background. If SLNs were positive, a completion ALND (cALND) was performed. The pathological report was also reviewed and analyzed. Results: SLNs were successfully identified in 243 (99.6%) of 244 patients, with metastases in SLNs identified in 28.0% of patients. An SLN was the only positive lymph node in 52.9% (36/68) of patients, with a positive SLN followed by a cALND. NSLNs metastases were found in 32/68 cases (47.1%). The rate of NSLN metastasis was positively correlated with the number of positive SLN (P=0.017). In SLN positive patients, the NSLN metastasis rate was 60.9% (28/46) in patient with a tumor-harboring last-order SLN (SLN with least isotope counts), but only 18.2% (4/22) in patients with a tumor-free SLN (P=0.001). Similar results were found in patients with either two or more metastatic SLNs (P= 0.023). Conclusion: In patients with a positive SLN, the number of metastatic SLNs and their isotope counts can be useful in the prediction of NSLNs metastasis. Further investigation will be necessary to confirm these results. (J Korean Surg Soc 2006;70:341-348) KCI Citation Count: 1