乳腺癌新辅助化疗后前哨淋巴结活检的研究
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摘要
目的:研究原发性乳腺癌患者在新辅助化疗(NAC)后进行前哨淋巴结活检(sLNI的可行性和准确性。
方法:对60例T1-3N0-2原发性乳腺癌患者先进行NAC 2-4周期,所有患者在NA后腋窝淋巴结临床检查为阴性。用亚甲兰皮下注射法对前哨淋巴结(SLN)进行定位。SLNB后常规实施腋窝淋巴结清扫(ALNC)。术后对所有淋巴结进行常规病理检查。
结果:
1.新辅助化疗的效果:NAC采用CTF方案35例,TA方案25例。每例应用2-4周期,共应用170周期,平均每例化疗2.8个周期。临床完全缓解(CR)8例(13.3%),临床部分缓解(PR)48例(80.0%),病情稳定(SD)4例(6.7%)。没有疾病进展(PD)和病理完全缓解(pCR)的病例。
2.前哨淋巴结活检的结果:60例患者中有55例成功地检出SLN,成功率91.7%(55/60)。每例检出1-4个SLN,平均每例2.6个SLN。55例成功检出SLN的患者中,SLN阳性25例,其中5例(9.1%)仅有SLN阳性。SLN阴性30例。SLN和非前哨淋巴结(NSLN)都为阳性20例,SLN和NSLN都为阴性27例,SLN为阳性而NSLN为阴性5例,SLN为阴性而NSLN为阳性3例。52例SLN的病理学准确预测了腋窝淋巴结(ALN)的病理学状态,准确率94.5%(52/55)。共有3例患者出现了假阴性,即SLN为阴性而NSLN却为阳性,假阴性率10.71%(3/28)。灵敏度89.3%(25/28)。
3.SLN的检出率与肿瘤发生的部位,NAC前肿瘤大小,NAC前腋窝淋巴结的状态及NAC的效果均沿有明显的关系。
结论:NAC后进行SLNB仍然能够取得较高的检出率和较低的假阴性率,其SLN的病理学状态能够较准确地预测ALN的病理学状态。对于NAC后成功检出SLN的乳腺癌患者,SLNB仍然可以作为取代ALND的一种选择。
Objective: To assess the feasibility and accuracy of sentinel lymph node biopsy (SLNB) in breast cancer patients following neoadjuvant chemotherapy (NAG).
Methods: A total of 60 consecutive patients with Stage II and III breast cancers,previously treated by NAC, were enrolled in the study. All patients were clinically node-negative after NAC. The patients underwent SLNB,which was mapped with a subdermal injection route over the tumor with methylene blue. This was followed by completion axillary lymph node dissection (ALND). All lymph nodes were examined by routine pathologic examination.
Results:
1. The outcome of NAC:8 (13.3%) patients achived complete response (CR) ,48 (80.0%) patients achived partial response (PR),4 (6.7%) patients achived stabledisease(SD).There were no PD and pCR patients.
2. The outcome of SLNB:SLNB was successful in 55 of 60 patients (detection rate 91.7%). 27 patients (49.1%) had negative nodes on both SLN and non-sentinel lymph node(NSLN), 28 (50.9%) had positive nodes on neither SLN or NSLN. In 5 patients (9.1%),the sentinel node was the only positive node identified. Overall, there was a 94.5%(52/55) concordance between SLN and ALN. There were 3 false negatives in 55 successfully mapped tumors, yielding an FNR of 10.71% (3/28).
3. The success rate of sentinel node identification shew no significant difference between the different locations of the tumor,the diffenrent sizes of the tumor befoe NAC,the different axillary lymph node status before NAC and the different clinical response of the tumor afer NAC.
Conclusion: Although the SLN identification rate decreased slightly and the false-negative rate increased slightly after neoadjuvant chemotherapy,SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.
方法:对60例T1-3N0-2原发性乳腺癌患者先进行NAC 2-4周期,所有患者在NA后腋窝淋巴结临床检查为阴性。用亚甲兰皮下注射法对前哨淋巴结(SLN)进行定位。SLNB后常规实施腋窝淋巴结清扫(ALNC)。术后对所有淋巴结进行常规病理检查。
结果:
1.新辅助化疗的效果:NAC采用CTF方案35例,TA方案25例。每例应用2-4周期,共应用170周期,平均每例化疗2.8个周期。临床完全缓解(CR)8例(13.3%),临床部分缓解(PR)48例(80.0%),病情稳定(SD)4例(6.7%)。没有疾病进展(PD)和病理完全缓解(pCR)的病例。
2.前哨淋巴结活检的结果:60例患者中有55例成功地检出SLN,成功率91.7%(55/60)。每例检出1-4个SLN,平均每例2.6个SLN。55例成功检出SLN的患者中,SLN阳性25例,其中5例(9.1%)仅有SLN阳性。SLN阴性30例。SLN和非前哨淋巴结(NSLN)都为阳性20例,SLN和NSLN都为阴性27例,SLN为阳性而NSLN为阴性5例,SLN为阴性而NSLN为阳性3例。52例SLN的病理学准确预测了腋窝淋巴结(ALN)的病理学状态,准确率94.5%(52/55)。共有3例患者出现了假阴性,即SLN为阴性而NSLN却为阳性,假阴性率10.71%(3/28)。灵敏度89.3%(25/28)。
3.SLN的检出率与肿瘤发生的部位,NAC前肿瘤大小,NAC前腋窝淋巴结的状态及NAC的效果均沿有明显的关系。
结论:NAC后进行SLNB仍然能够取得较高的检出率和较低的假阴性率,其SLN的病理学状态能够较准确地预测ALN的病理学状态。对于NAC后成功检出SLN的乳腺癌患者,SLNB仍然可以作为取代ALND的一种选择。
Objective: To assess the feasibility and accuracy of sentinel lymph node biopsy (SLNB) in breast cancer patients following neoadjuvant chemotherapy (NAG).
Methods: A total of 60 consecutive patients with Stage II and III breast cancers,previously treated by NAC, were enrolled in the study. All patients were clinically node-negative after NAC. The patients underwent SLNB,which was mapped with a subdermal injection route over the tumor with methylene blue. This was followed by completion axillary lymph node dissection (ALND). All lymph nodes were examined by routine pathologic examination.
Results:
1. The outcome of NAC:8 (13.3%) patients achived complete response (CR) ,48 (80.0%) patients achived partial response (PR),4 (6.7%) patients achived stabledisease(SD).There were no PD and pCR patients.
2. The outcome of SLNB:SLNB was successful in 55 of 60 patients (detection rate 91.7%). 27 patients (49.1%) had negative nodes on both SLN and non-sentinel lymph node(NSLN), 28 (50.9%) had positive nodes on neither SLN or NSLN. In 5 patients (9.1%),the sentinel node was the only positive node identified. Overall, there was a 94.5%(52/55) concordance between SLN and ALN. There were 3 false negatives in 55 successfully mapped tumors, yielding an FNR of 10.71% (3/28).
3. The success rate of sentinel node identification shew no significant difference between the different locations of the tumor,the diffenrent sizes of the tumor befoe NAC,the different axillary lymph node status before NAC and the different clinical response of the tumor afer NAC.
Conclusion: Although the SLN identification rate decreased slightly and the false-negative rate increased slightly after neoadjuvant chemotherapy,SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.
引文
1 Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol JT -Surgical oncology, 1993,2(6):335-9; discussion 340.
2 Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg JT - Annals of surgery, 1994,220(3):391-8; discussion 398-401.
3 Kang SH, Kang JH, Choi EA, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy. Breast Cancer JT - Breast cancer (Tokyo, Japan), 2004,11(3):233-41; discussion 264-6.
4 Ferrari A, Rovera F, Dionigi P, et al. Sentinel lymph node biopsy as the new standard of care in the surgical treatment for breast cancer. Expert Rev Anticancer Ther JT -Expert review of anticancer therapy, 2006,6( 10): 1503-15.
5 Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst JT- Journal of the National Cancer Institute, 2006,98(9):599-609.
6 Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg JT- American journal of surgery, 2005, 189(2): 236-9.
7 Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer JT - Cancer, 2006, 106(1):4-16.
8 Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer JT - Cancer, 2002,94(10):2542-51.
9 Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med JT - The New England journal of medicine, 2003,349(6):546-53.
10 Posther KE, Wilke LG, Giuliano AE. Sentinel lymph node dissection and the current status of American trials on breast lymphatic mapping. Semin Oncol JT - Seminars in oncology, 2004,31(3):426-36.
11 Kim R, Osaki A, Toge T. Current and future roles of neoadjuvant chemotherapy in operable breast cancer. Clin Breast Cancer JT - Clinical breast cancer, 2005,6(3):223-32; discussion 233-4.
12 Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005,23(30):7703-20.
13 Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer JT - Cancer, 2000,89(11):2187-94.
14 Kang SH, Kim SK, Kwon Y, et al. Decreased identification rate of sentinel lymph node after neoadjuvant chemotherapy. World J Surg JT - World journal of surgery, 2004,28(10):1019-24.
15 Fernandez A, Cortes M, Benito E, et al. Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme. Nucl Med Commun JT - Nuclear medicine communications, 2001,22(4):361 -6.
16 Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2000,18(20):3480-6.
17 Stearns V, Ewing CA, Slack R, et al. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol JT - Annals of surgical oncology, 2002,9(3):235-42.
18 Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005,23(12):2694-702.
19 Xing Y, Foy M, Cox DD, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg JT - The British journal of surgery, 2006,93(5):539-46.
20 Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat JT - Breast cancer research and treatment, 2006,99(2):203-8.
21 Martin RC 2nd, Chagpar A, Scoggins CR, et al. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg JT -Annals of surgery, 2005,241(6):1005-12; discussion 1012-5.
1 Khan A, Vohra P, Quinlan RF. The role of sentinel lymph node biopsy in the management of breast cancer. Indian J Pathol Microbiol JT - Indian journal of pathology & microbiology, 2007,50(2):261-9.
2 Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol JT -Surgical oncology, 1993,2(6):335-9; discussion 340.
3 Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg JT - Annals of surgery, 1994, 220(3): 391-8; discussion 398-401.
4 Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer JT - Cancer, 2006, 106(1):4-16.
5 Clarke D, Khonji NI, Mansel RE. Sentinel node biopsy in breast cancer: ALMANAC trial. World J Surg JT - World journal of surgery, 2001,25(6):819-22.
6 Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007,25(24):3657-63.
7 Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg JT - American journal of surgery, 2005, 189 (2): 236-9.
8 Povoski SP, Olsen JO, Young DC, et al. Prospective randomized clinical trial comparing intradermal, intraparenchymal, and subareolar injection routes for sentinel lymph node mapping and biopsy in breast cancer. Ann Surg Oncol JT - Annals of surgical oncology, 2006,13(11):1412-21.
9 Zakaria S, Degnim AC, Kleer CG, et al. Sentinel lymph node biopsy for breast cancer:how many nodes are enough?. J Surg Oncol JT - Journal of surgical oncology, 2007,96(7):554-9.
10 Woznick A, Franco M, Bendick P, et al. Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?. Am J Surg JT - American journal of surgery, 2006,191(3):330-3.
11 Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol JT - The lancet oncology, 2007,8(10):881-8.
12 Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat JT - Breast cancer research and treatment, 2006,99(2):203-8.
13 Martin RC 2nd, Chagpar A, Scoggins CR, et al. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg JT -Annals of surgery, 2005,241(6):1005-12; discussion 1012-5.
14 Bergkvist L, Frisell J, Liljegren G, et al. Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancer. Br J Surg JT - The British journal of surgery, 2001,88(12): 1644-8.
15 Beach RA, Lawson D, Waldrop SM, et al. Rapid immunohistochemistry for cytokeratin in the intraoperative evaluation of sentinel lymph nodes for metastatic breast carcinoma. Appl Immunohistochem Mol Morphol JT - Applied immunohistochemistry & molecular morphology : AIMM / official publication of the Society for Applied Immunohistochemistry, 2003,1 l(1):45-50.
16 Zhang T, Zhang BN, Zhang HT, et al. [Detection of micrometastases in sentinel lymph nodes of breast cancer]. Zhonghua Zhong Liu Za Zhi JT - Zhonghua zhong liu za zhi [Chinese journal of oncology], 2007,29(2): 116-8.
17 Ryden L, Chebil G, Sjostrom L, et al. Determination of sentinel lymph node (SLN) status in primary breast cancer by prospective use of immunohistochemistry increases the rate of micrometastases and isolated tumour cells: analysis of 174 patients after SLN biopsy. Eur J Surg Oncol JT - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2007,33(1):33-8.
18 de Mascarel I, Macgrogan G, Debled M, et al. Distinction between isolated tumor cells and micrometastases in breast cancer: is it reliable and useful?. Cancer JT -Cancer, 2008,112(8): 1672-8.
19 Cox CE, Kiluk JV, Riker AI, et al. Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg JT - Journal of the American College of Surgeons, 2008,206(2):261-8.
20 Veronesi U, Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol JT - The lancet oncology, 2006,7(12):983-90.
21 Zavagno G, Carcoforo P, Franchini Z, et al. Axillary recurrence after negative sentinel lymph node biopsy without axillary dissection: a study on 479 breast cancer patients. Eur J Surg Oncol JT - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2005,31(7):715-20.
22 Posther KE, Wilke LG, Giuliano AE. Sentinel lymph node dissection and the current status of American trials on breast lymphatic mapping. Semin Oncol JT - Seminars in oncology, 2004,31(3):426-36.
2 Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg JT - Annals of surgery, 1994,220(3):391-8; discussion 398-401.
3 Kang SH, Kang JH, Choi EA, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy. Breast Cancer JT - Breast cancer (Tokyo, Japan), 2004,11(3):233-41; discussion 264-6.
4 Ferrari A, Rovera F, Dionigi P, et al. Sentinel lymph node biopsy as the new standard of care in the surgical treatment for breast cancer. Expert Rev Anticancer Ther JT -Expert review of anticancer therapy, 2006,6( 10): 1503-15.
5 Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst JT- Journal of the National Cancer Institute, 2006,98(9):599-609.
6 Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg JT- American journal of surgery, 2005, 189(2): 236-9.
7 Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer JT - Cancer, 2006, 106(1):4-16.
8 Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer JT - Cancer, 2002,94(10):2542-51.
9 Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med JT - The New England journal of medicine, 2003,349(6):546-53.
10 Posther KE, Wilke LG, Giuliano AE. Sentinel lymph node dissection and the current status of American trials on breast lymphatic mapping. Semin Oncol JT - Seminars in oncology, 2004,31(3):426-36.
11 Kim R, Osaki A, Toge T. Current and future roles of neoadjuvant chemotherapy in operable breast cancer. Clin Breast Cancer JT - Clinical breast cancer, 2005,6(3):223-32; discussion 233-4.
12 Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005,23(30):7703-20.
13 Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer JT - Cancer, 2000,89(11):2187-94.
14 Kang SH, Kim SK, Kwon Y, et al. Decreased identification rate of sentinel lymph node after neoadjuvant chemotherapy. World J Surg JT - World journal of surgery, 2004,28(10):1019-24.
15 Fernandez A, Cortes M, Benito E, et al. Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme. Nucl Med Commun JT - Nuclear medicine communications, 2001,22(4):361 -6.
16 Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2000,18(20):3480-6.
17 Stearns V, Ewing CA, Slack R, et al. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol JT - Annals of surgical oncology, 2002,9(3):235-42.
18 Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005,23(12):2694-702.
19 Xing Y, Foy M, Cox DD, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg JT - The British journal of surgery, 2006,93(5):539-46.
20 Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat JT - Breast cancer research and treatment, 2006,99(2):203-8.
21 Martin RC 2nd, Chagpar A, Scoggins CR, et al. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg JT -Annals of surgery, 2005,241(6):1005-12; discussion 1012-5.
1 Khan A, Vohra P, Quinlan RF. The role of sentinel lymph node biopsy in the management of breast cancer. Indian J Pathol Microbiol JT - Indian journal of pathology & microbiology, 2007,50(2):261-9.
2 Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol JT -Surgical oncology, 1993,2(6):335-9; discussion 340.
3 Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg JT - Annals of surgery, 1994, 220(3): 391-8; discussion 398-401.
4 Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer JT - Cancer, 2006, 106(1):4-16.
5 Clarke D, Khonji NI, Mansel RE. Sentinel node biopsy in breast cancer: ALMANAC trial. World J Surg JT - World journal of surgery, 2001,25(6):819-22.
6 Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007,25(24):3657-63.
7 Thevarajah S, Huston TL, Simmons RM. A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg JT - American journal of surgery, 2005, 189 (2): 236-9.
8 Povoski SP, Olsen JO, Young DC, et al. Prospective randomized clinical trial comparing intradermal, intraparenchymal, and subareolar injection routes for sentinel lymph node mapping and biopsy in breast cancer. Ann Surg Oncol JT - Annals of surgical oncology, 2006,13(11):1412-21.
9 Zakaria S, Degnim AC, Kleer CG, et al. Sentinel lymph node biopsy for breast cancer:how many nodes are enough?. J Surg Oncol JT - Journal of surgical oncology, 2007,96(7):554-9.
10 Woznick A, Franco M, Bendick P, et al. Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?. Am J Surg JT - American journal of surgery, 2006,191(3):330-3.
11 Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol JT - The lancet oncology, 2007,8(10):881-8.
12 Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer—results of the ALMANAC validation phase. Breast Cancer Res Treat JT - Breast cancer research and treatment, 2006,99(2):203-8.
13 Martin RC 2nd, Chagpar A, Scoggins CR, et al. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg JT -Annals of surgery, 2005,241(6):1005-12; discussion 1012-5.
14 Bergkvist L, Frisell J, Liljegren G, et al. Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancer. Br J Surg JT - The British journal of surgery, 2001,88(12): 1644-8.
15 Beach RA, Lawson D, Waldrop SM, et al. Rapid immunohistochemistry for cytokeratin in the intraoperative evaluation of sentinel lymph nodes for metastatic breast carcinoma. Appl Immunohistochem Mol Morphol JT - Applied immunohistochemistry & molecular morphology : AIMM / official publication of the Society for Applied Immunohistochemistry, 2003,1 l(1):45-50.
16 Zhang T, Zhang BN, Zhang HT, et al. [Detection of micrometastases in sentinel lymph nodes of breast cancer]. Zhonghua Zhong Liu Za Zhi JT - Zhonghua zhong liu za zhi [Chinese journal of oncology], 2007,29(2): 116-8.
17 Ryden L, Chebil G, Sjostrom L, et al. Determination of sentinel lymph node (SLN) status in primary breast cancer by prospective use of immunohistochemistry increases the rate of micrometastases and isolated tumour cells: analysis of 174 patients after SLN biopsy. Eur J Surg Oncol JT - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2007,33(1):33-8.
18 de Mascarel I, Macgrogan G, Debled M, et al. Distinction between isolated tumor cells and micrometastases in breast cancer: is it reliable and useful?. Cancer JT -Cancer, 2008,112(8): 1672-8.
19 Cox CE, Kiluk JV, Riker AI, et al. Significance of sentinel lymph node micrometastases in human breast cancer. J Am Coll Surg JT - Journal of the American College of Surgeons, 2008,206(2):261-8.
20 Veronesi U, Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol JT - The lancet oncology, 2006,7(12):983-90.
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