Thymidine labeling index in breast tumors.

The relationship between primary tumor proliferative activity and clinical and pathologic characteristics was analyzed in relation to menopausal status in 32 patients with malignant or benign breast disease. The thymidine labeling index (TLI) showed significantly higher median values in the cancer patients (3.48 per cent) than in the patients with benign diseases (1.02 per cent). TLI was not significantly affected by delayed incubation at room temperature for about 1 hour. In the breast cancer patients, TLI did not significantly correlate to tumor size, the presence of axillary lymph node metastasis or pathologic nuclear grading. The only significant difference was limited to the breast cancer patients without axillary lymph node metastasis in relation to menopausal status; the TLI in the premenopausal patients (5.10 per cent) was significantly higher (p less than 0.05) than that in the postmenopausal patients (2.28 per cent). These data thus suggest that among premenopausal patients without axillary lymph node metastasis, those with a high TLI could be potential candidates for adjuvant chemotherapy.     

Axillary lymph node dissection in breast cancer: an evolving question?

Axillary lymph node dissection (ALND) is performed for staging purposes. Sentinel lymph node biopsy may decrease the cost and morbidity of ALND. Are there patients that the procedure is not indicated avoiding cost and morbidity? We retrospectively studied the incidence of lymph node metastasis in 423 patients with T1 breast cancer. Thirty-one T1a, 146 T1b, and 246 T1c tumors were seen. The mean age was 61 years. Ten per cent were premenopausal, and 84 per cent were postmenopausal. Tumor size averaged 1.29 cm. Eighty-one per cent of the tumors were node negative and 19 per cent were node positive. One T1a patient (3 per cent) had an axillary metastasis, 19 T1b patients (13%), and 61 T1c patients (25%) were node positive, respectively. Seventy-three per cent were ER positive. Thirty-three patients (8%) died from cancer. Eighty-seven per cent received surgery with axillary lymph node dissection (ALND), and three per cent had surgery without ALND. Younger age, increased tumor size, premenopausal status, and ER negativity affected node positivity rates (P < 0.05). Death from breast cancer was more common among node-positive patients (P < 0.05). No difference was found regarding the performance of ALND and survival (P > 0.05). We feel that ALND can be safely omitted in T1a to reduce the morbidity and the expense of breast cancer treatment. In T1b and T1c tumors, the use of ALND is necessary, but morbidity and cost can be reduced by the use of sentinel lymph node biopsy.     

Adjuvant radiation after modified radical mastectomy for breast cancer fails to prolong survival

Recent literature has reported improved local disease control and overall survival in premenopausal node-positive (stage II, and III) breast cancer patients undergoing modified radical mastectomy (MRM) using radiation therapy (RT) combined with chemotherapy. To assess the efficacy of postoperative RT in our own community, we analyzed all patients undergoing MRM for carcinoma utilizing an extensive database from the three major teaching hospitals in Tulsa, OK, between 1965 and 1993. A total of 5257 patients underwent MRM during this time period. One hundred thirty-seven patients were excluded for insufficient data or because they were found to be at stage IV, leaving a total study population of 5125. Overall survival (OS), overall mean survival (MS), disease-free survival (DFS), and locoregional DFS (LRDFS) were analyzed for all patients and were further analyzed according to stage, lymph node involvement, and menopausal status. Median follow-up was 103 months. Statistical analysis was performed using Kaplan-Meier and t-tests. The DFS at 10 years was 65 per cent in the RT group and 80 per cent in the patients who did not receive RT (P = 0.00). No improved DFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. Similarly, the LRDFS at 10 years was 91 per cent in the RT group and 96 per cent in the patients who did not receive RT (P = 0.00). No improved LRDFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. The overall MS was 97 months in the RT group and 104 months in the patients who did not receive RT (P = 0.00). Comparisons of overall MS rates revealed apparent survival benefits from RT in the premenopausal node-negative group, postmenopausal one to four-positive-node group, and all stage I patients. This apparent survival advantage was not confirmed by Kaplan-Meier curves of OS. No other overall MS differences were detected according to stage, lymph node, or menopausal status. Using Kaplan-Meier survival curves, the OS in the RT group at 10 years was 46 per cent, and 63 per cent in the patients who did not receive RT (P = 0.00). No improved OS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. These findings from a large breast cancer database failed to demonstrate any meaningful benefit from RT after MRM and serve to further question the efficacy of this treatment modality in postmastectomy breast cancer patients.     

乳腺疾病中血管内皮生长因子的表达及其意义

目的 观察乳腺良恶性疾病中血管内皮生长因子（VEGF）的表达状况以及与肿瘤大小、临床分期、血行转移、腋淋巴结转移等预后因素的关系。方法 用免疫组化LSAB法分析了70例乳腺浸润性导管癌、30例良性乳腺病和7例癌旁组织中VEGF的蛋白表达情况。结果 乳癌组和癌旁组VEGF表达水平显著高于良性病组。有血行转移或淋巴结转移组VEGF表达水平高于无转移组，而在其他预后因素中分布无差异。结论 VEGF表达水平对判定乳腺疾病良恶性及乳癌血行转移或淋巴转移的可能性有一定的预示价值。     

Luminal A型早期乳腺癌化疗决策的影响因素分析

目的:分析腔内细胞(luminal)A型早期乳腺癌的临床病理特征对化疗决策的影响。方法:回顾性分析2010年11月至2013年12月我院收治的232例luminal A型早期女性乳腺癌病人的临床病理资料及治疗方法。采用χ2检验和Logistic回归分析其化疗决策的影响因素。结果:232例病人行保乳手术或乳房切除术,前哨淋巴结活检或腋清,其中72例(31.0%)接受术后辅助化疗。单因素分析显示不同的年龄组、月经状态、淋巴结转移、组织学分级、病理类型和手术方式的病人,其化疗比例表现出明显的差异,而雌激素受体和孕激素受体的表达量并未影响其化疗决策。多因素分析表明淋巴结1~3枚阳性病人的化疗比例显著高于淋巴结阴性病人(75.9%比16.1%,OR=27.302,P0.001)。绝经后病人化疗比例明显低于绝经前病人(20.1%比47.3%,OR=0.173,P=0.018)。70岁病人只有1例接受化疗,明显低于≤50岁的病人(OR=0.039,P=0.014)。在淋巴结阴性的病人中,多因素分析显示绝经后病人接受化疗的比例显著低于绝经前病人(7.5%比29.4%,OR=0.146,P=0.040)。结论:淋巴结转移、年龄和月经状态是影响luminal A型早期乳腺癌化疗决策的重要因素。70岁以上病人或淋巴结阴性的绝经后病人倾向于不接受化疗。     

临床T1、T2 N0 M0乳腺癌腋窝淋巴结转移状况研究的意义

目的 探讨临床T1、T2、 N0、M0.乳腺癌腋窝淋巴结转移状况及临床意义.方法 结合原发肿瘤位置、年龄、病理等,分析了276例临床T1、T2 N0M0乳腺癌患者腋窝淋巴结转移情况及意义.结果 临床T1 N0M0.腋淋巴结转移率低于T2 N0M0乳腺癌患者(P=0.027),乳腺中央区与外下象限乳腺癌发生腋淋巴结转移明显高于其他部位肿瘤(P=0.004);乳腺外侧象限肿瘤腋窝下组淋巴结转移率高于其他部位肿瘤组(P=0.000);乳头中央区和内侧象限乳腺癌腋上组淋巴结转移高于乳腺外侧象限肿瘤(P=0.000).非特殊型癌发生淋巴结转移明显高于早期癌和其他类型(P-0.001).9例单纯癌6例发生2组以上腋淋巴结转移.90例发生腋淋巴结转移的病例中,>50岁者62例(68.9%)发生腋淋巴结转移,≤50岁者28例(31.1%)发生腋淋巴结转移(P=0·000).发现"跳跃式"转移病例2例(0.7%),均为临床T2 N0M0患者,肿瘤位于乳头中央区1例,外下象限者1例.其中浸润型导管癌1例,单纯癌1例.结论 研究临床T1、T2 N0M0乳腺癌腋窝转移淋巴结分布情况对开展SLNB及制定合理的治疗方案有一定指导价值.     

乳腺癌c-erbB-2与雌孕激素受体及淋巴结转移的相关性分析

目的：分析乳腺癌c-erbB-2的表达与ER、PR，以及腋窝淋巴结、肿瘤大小、病理类型的相关性。方法：收集术前未行新辅助化疗而行手术切除加腋窝清扫的乳腺癌病人346例，采用免疫组化法检测c-erbB-2、ER及PR；比较c-erbB-2表达与ER、PR、腋窝淋巴结、肿瘤大小以及病理类型之间的关系。结果：c-erbB-2阳性表达者占48．2％，腋窝淋巴结有转移者的c-erbB-2阳性表达为69．6％，而淋巴结阴性者则为34．6％（P〈0．001）。ER、PR均阳性且c-erbB-2表达也阳性者为38．1％；而ER、PR均阴性、c-erbB-2阳性者达64．6％（P〈0．001）。仅ER阳性和阴性者的c-erbB-2阳性表达分别是40．7％和69.2％（P（0．001）。仅PR阳性和阴性者的c-erbB-2阳性分别为46．4％和49．7％（P〉0．05）。〈2cm和2～5cm肿瘤的c-erbB-2阳性率分别是47．1％和48．8％（P〉0．05）。导管内癌和黏液癌的c-erbB-2表达阳性率分别达73．8％和60．0％。结论：c-erbB-2阳性表达与腋窝淋巴结的转移呈正相关，与ER呈负相关，与PR和肿瘤大小不相关。c-erbB-2是判断乳腺癌预后的良好指标。     

Nonsentinel lymph node status after positive sentinel lymph node biopsy in early breast cancer

Axillary dissection is the current standard of care for patients with breast cancer who are diagnosed with metastasis to axillary sentinel lymph nodes (SLNs). Recently, that concept has come under increasing scrutiny because not all women with a positive SLN will need further dissection. The purpose of this study was to look at nonsentinel lymph node status in patients with breast cancer and axillary SLN metastasis in an effort to determine tumor variables that can guide further treatment if there are additional axillary nodes involved. A retrospective chart review was performed on patients with breast cancer who underwent SLN biopsy between July 1998 and April 2003. Chi2 analysis, Student t test, and multivariate analysis were used to determine the significance of tumor size, grade, location, estrogen receptor (ER) and progestrone receptor (PR) receptor status, angiolymphatic invasion, stage, and number and size of SLNs in predicting the status of nonsentinel lymph nodes. During the study interval, 116 patients were identified who underwent SLN biopsy and 34 (29.3%) had positive SLNs. All of these patients underwent complete axillary node dissection and 11 patients (32.3%) had non-SLN metastasis. The presence of palpable breast mass (P = 0.03), tumor size (P = 0.04), angiolymphatic invasion (P = 0.03), and extracapsular extension of SLN metastasis (P = 0.001) were the variables that predicted non-SLN involvement. Micrometastasis was inversely related to non-SLN involvement. In patients with breast cancer and SLN metastasis, the presence of a palpable breast mass, tumor size, angiolymphatic invasion, and extracapsular node extension increase the likelihood of identifying additional node metastasis on subsequent axillary dissection.     

Bilateral axillary metastases of occult breast carcinoma: report of a case with a review of the literature

The case of a 47-year-old premenopausal woman is presented in whom axillary lymph node metastases occurred on both sides 3 years apart although no primary tumor was detectable in either breast is presented. An overview of the literature on this rare entity is given. Patients with occult breast carcinoma with axillary lymph node metastases should have a complete physical examination, radiologic analysis (mammography, ultrasonography, and MRI of both breasts) and screening for disseminated disease. If there is no evidence of a primary tumor and metastases other than in the axilla, an axillary dissection should be carried out. In addition, the patient should be offered the choice of irradiation of the breast or mastectomy. Postoperatively, patients should receive appropriate systemic therapy tailored to their age, menopausal status, and receptor status.     

BRMS1mRNA在乳腺癌组织中的表达及其意义

摘要：目的 探讨乳腺癌转移抑制基因BRMS1mRNA在乳腺癌组织中的表达及其临床意义。方法 用逆转录聚合酶链反应（RT PCR）技术检测71例乳腺癌、71例癌旁组织及12例乳腺良性肿瘤、12例正常乳腺组织中BRMS1mRNA的表达，半定量分析RT PCR产物电泳条带密度。结果 在71例乳腺癌及其相应癌旁组织中BRMS1mRNA表达水平分别为0.378±0.046和 0.918±0.044；12例乳腺良性肿瘤及正常乳腺组织表达水平分别为0.908±0.047和 0.934±0.028；乳腺癌组织BRMS1mRNA的表达水平明显低于癌旁组织、乳腺良性肿瘤和正常乳腺组织(P<0.01)。BRMS1mRNA的表达水平与患者年龄、肿瘤大小、ER和 PR无关 (P>0.05)，而腋淋巴结有转移及临床分期III，IV期者其表达水平低于无淋巴结转移和临床分期I，II期者(P<0.05)。结论 BRMS1mRNA在乳腺癌组织中表达水平下降；其表达与乳腺癌腋淋巴结转移、临床分期有关，可能成为乳腺癌转移和预后的指标之一。     

NuSAP在乳腺癌中的表达及临床意义

目的:探讨乳腺癌组织中新型微管结合蛋白Nu SAP的表达及临床意义。方法:选取乳腺癌组织50例,与相应癌旁正常乳腺组织37例(距癌灶5 cm以上)以及乳腺良性病变组织20例,分别用免疫组化与实时荧光定量PCR方法检测Nu SAP蛋白与m RNA的表达,分析Nu SAP表达与乳腺癌患者临床病理特征的关系。结果:Nu SAP蛋白与m RNA在乳腺癌组织中的表达水平明显高于癌旁正常组织和乳腺良性病变组织(均P0.05);Nu SAP蛋白与m RNA的表达均在有腋窝淋巴结转移、HER-2表达阳性的乳腺癌组织中明显升高(均P0.05),而与绝经状态、年龄以及ER、PR、Ki-67的表达无关(均P0.05)。结论:Nu SAP在乳腺癌组织中的表达升高,且可能与乳腺癌的发生、发展及侵袭密切相关。     

Lymph node metastasis in breast cancer: Common prognostic markers lack predictive value

Background: The purpose of this study was to determine whether routine biologic tumor markers can predict lymph node status. The authors attempted to discover whether predictors of axillary lymph node metastasis based on biologic characteristic of primary breast cancers exist. Methods: Eight hundred and fifty-one patients with invasive breast cancer who underwent surgical treatment, including axillary lymph node dissection, at a tertiary referral center were studied. Univariate and multivariate analysis were performed on prospectively gathered data from a breast cancer registry, including pathology, site of primary lesion in the breast, estrogen and progesterone receptor status, DNA index, S-phase fraction, nuclear grade, and extensive intraductal component. Outcome was determined by (1) the presence of any lymph node metastasis and (2) the presence of 10 or more lymph node metastases. Results: The only independent predictors of lymph node metastasis were primary tumor size and pathology. For predicting 10 or more metastases, only size and ER-negative status were independent predictors. These factors accounted for less than 20% of the regression, implying that more than 80% of lymph node metastases are not explained by the regression model. Lymph node metastases were seen in 8.3% of T1a, 15.3% of T1b, and 30.7% of T1c lesions. Conclusions: Biologic tumor markers are not reliable predictors of lymph node metastasis, except possibly for T1a lesions, therefore direct pathologic evaluation of lymph node status cannot be abandoned. Efforts to determine lymph node status through other methods such as sentinel lymph node biopsy are warranted.     

Percent positive axillary involvement predicts for the development of brain metastasis in high-risk patients with nonmetastatic breast cancer receiving post-mastectomy radiotherapy

Abstract:  We retrospectively assessed the predictive factors for brain metastasis in high-risk breast cancer patients receiving radiotherapy after mastectomy. Between January 1994 and 2002, the medical charts of nonmetastatic breast cancer patients receiving post-mastectomy radiotherapy were evaluated. The clinical and pathologic features of patients who developed brain metastasis as the first site metastatic disease were compared with nonmetastatic patients treated at the same time period. All eligible patients in this study were treated with postoperative radiotherapy ± chemotherapy. Age, stage, percent positive lymph node involvement, number of lymph node metastasis, primary tumor size, grade, surgical margin status, estrogen receptor status, and perinodal fat tissue invasion were analyzed as predictive factors for brain metastasis. Statistical analyses were performed by using Log-rank test and Cox's regression analysis. Median follow-up-time was 61 months. In this period, 32 out of 957 patients (3.3%) developed brain metastasis. In univariate analysis percent positive axillary lymph node involvement (p < 0.001), primary tumor size (p < 0.001), number of lymph node metastasis (p = 0.01), and American Joint Committee on Cancer 2002 stage (p < 0.001) were found to be predictive for brain metastasis. Multivariate analysis revealed that only the primary tumor size and percent positive lymph node involvement were significant predictive factors for the development of brain metastasis. The primary tumor size and percent positive lymph node involvement increases the risk of brain metastasis in patients with nonmetastatic breast cancer receiving postoperative radiotherapy and chemotherapy.     

Predicting nodal status using dynamic contrast-enhanced magnetic resonance imaging in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy with and without sequential trastuzumab

HYPOTHESIS: Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) is a reliable and accurate method for monitoring primary tumor response in the breast and can be used as a surrogate to predict final axillary nodal status. DESIGN: Retrospective study (October 1, 2004, through February 28, 2006) of 46 patients with clinically staged locally advanced breast cancer. SETTING: Comprehensive cancer center. PATIENTS: Forty-six patients with locally advanced breast cancer. INTERVENTIONS: Neoadjuvant chemotherapy (NAC), DCE-MRI, mastectomy and lumpectomy, and axillary lymph node dissection. MAIN OUTCOME MEASURES: The DCE-MRI results and pathologic response of the breast and axillary lymph nodes. RESULTS: Forty-six patients underwent NAC with doxorubicin hydrochloride and cyclophosphamide, followed by paclitaxel and carboplatin, with or without trastuzumab based on human epidermal growth factor receptor 2 (HER2/neu) status. Twenty-one patients (46%) had a complete pathologic response. For the HER2/neu-positive patients, the complete pathologic response rate was 70% (14/20). The accuracy, sensitivity, and specificity of the primary tumor response in predicting the axillary nodal status were 78%, 88%, and 72%, respectively. The accuracy, sensitivity, and specificity of the DCE-MRI-measured response in the primary tumor in predicting axillary nodal status were 74%, 62%, and 82%, respectively. For the HER2/neu-positive patients, the accuracy, sensitivity, and specificity improved to 80%, 75%, and 82%, respectively. CONCLUSIONS: The results of DCE-MRI of the primary tumor can be predictive of axillary nodal status, especially in patients receiving trastuzumab who are HER2/neu positive. The HER2/neu-positive patients with a complete clinical response on DCE-MRI are highly unlikely to benefit from an axillary lymph node dissection. For HER2/neu-negative patients, sentinel lymph node sampling is warranted.     

Radiation after mastectomy in high-risk patients: is it necessary?

A retrospective review of cases from 1988 through 1992 was performed examining high-risk breast cancer patients treated with modified radical mastectomy without postoperative radiation at a single institution. Locoregional recurrence, distant metastases, overall survival, and number of lymph nodes removed were examined. This was compared with recent Danish and Canadian studies. Thirty-three premenopausal node-positive breast cancer patients had a 9 per cent locoregional recurrence rate. In the Danish and Canadian studies the locoregional recurrence rates were 32 and 21 per cent. These were reduced to 9 per cent and 10 per cent respectively in the radiated arms. Our locoregional recurrence in nonradiated patients was similar to that in the radiated arms of the studies and improved when compared with recurrence in their non-radiated controls. The adequacy of the axillary lymph node dissection was examined. In the current study a median of 18 lymph nodes were recovered with only 3 per cent containing less than 12 nodes. In the Danish study a median of seven lymph nodes were removed. Similarly in the Canadian trial a median of 11 nodes were removed. With complete axillary dissection results equivalent to those of postoperative adjuvant radiation is achieved. Further randomized controlled studies with standard axillary dissections are needed before the recommendation of routine postoperative radiotherapy.     

Axillary lymph node status of T1 primary breast cancer in a diverse population

The utility of level I and II axillary lymph node dissection in women with primary tumors less than 1 cm in diameter has recently received extensive evaluation. Numerous patients undergo axillary lymph node dissection ultimately to discover no pathological involvement. This study investigates the lymph node status in T1 primary breast adenocarcinoma in our diverse patient population. A retrospective evaluation of patients treated at the Medical Center of Louisiana at New Orleans and the Tulane University Medical Center with breast adenocarcinoma less than or equal to 2 cm was performed. Demographic data and pathological reports were reviewed to obtain breast lesion size and lymph node status. One hundred sixteen patients were found to have T1 lesions. Ethnic distribution was African American 66 per cent; Caucasians 30 per cent; Hispanic 2 per cent; and Asian 3 per cent. Whereas no patients with T1a lesions had positive lymph nodes, 11 per cent of patients with T1b lesions and 36 per cent of patients with T1c lesions had positive lymph nodes. However, in our patient population no patients with tumors less than 1.0 cm. in diameter had positive lymph nodes. Although this may be due to our relatively small sample size axillary lymph node dissection may be unnecessary in this select patient population. For patients with lesions 1.0 cm and greater an axillary lymph node dissection seems to add necessary information for correct treatment in a small percentage of patients. The use of lymphatic mapping with sentinel axillary lymph node biopsy may reduce the number of unnecessary axillary dissections in early breast cancer.     

血管内皮生长因子-C与乳腺癌淋巴结转移关系的研究

目的 探讨血管内皮生长因子-C(vascular endothelial growth factor-C, VEGF-C)的表达与乳腺癌淋巴结转移的关系.方法 应用免疫组化法观察78例乳腺浸润性导管癌组织中VEGF-C的表达情况,评价VEGF-C表达与淋巴结转移及其他临床病理因素的关系.取20例乳腺纤维腺瘤标本做对照.结果 78例乳腺浸润性导管癌中52例VEGF-C呈阳性表达,阳性率为67%;对照组仅3例可见VEGF-C弱表达,阳性率为15%.乳腺癌组VEGF-C表达阳性率明显高于对照组,差异有统计学意义(P<0.01);乳腺癌腋淋巴结转移组VEGF-C表达阳性者阳性率(78%)明显高于腋淋巴结无转移组(48%),差异有统计学意义(P<0.05);VEGF-C表达与患者年龄、肿瘤大小、激素受体、及临床分期之间差异无统计学意义(P>0.05).结论 VEGF-C与乳腺癌淋巴结转移呈正相关,是乳腺癌重要预后因子.     

PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价

目的：评价PET／CT诊断乳腺癌和腋窝淋巴结转移的临床价值。方法：对33例疑似乳腺癌病人进行PET／CT检查，定性分析肿瘤病灶、淋巴结摄取氟脱氧葡萄糖（FDG）的程度，半定量测量标准摄取值（SUV），根据乳腺和淋巴结的FDG摄取强度诊断乳腺癌和淋巴结转移，检验SUV与乳腺癌分化程度、有丝分裂计数的关联性。结果：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度和精确度分别为92．6％、100％、93．9％和82．3％、90％、85．2％；SUV与乳腺癌分化程度、有丝分裂计数显著相关（P〈0．05）；诊断乳腺癌的Kappa指数=0．835，μ=8．48，（P〈0．01）。结论：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度较高，作为一种非侵袭性检查方法，可提供乳腺癌在活体内的多方面生物学信息，为选择合理的手术方式及新辅助化疗提供参考，弥补传统检查方法的不足。     

乳腺癌哨兵淋巴结转移与肿瘤大小和癌基因及激素受体表达关系的临床观察

目的：探讨影响乳腺癌哨兵淋巴结转移的相关因素。方法：回顾性分析近2年来原发性乳腺癌115例临床资料。行哨兵淋巴结活检（SLNB）与腋窝淋巴结清扫术（ALND）;肿瘤直径≤2cm和2.1~4cm;免疫组化法检测肿瘤组织中C erbB 2，（HER 2/neu）p53，nm23，ER和PR的表达状态及对哨兵淋巴结（SN）转移的影响程度。结果：115例乳腺癌SN检出110例（检出率95.65％）,哨兵淋巴结与腋淋巴结病理结果完全符合，同时相关资料齐全可供分析的95例。其中SN转移36例（37.89％）,SN无转移59例（62.11％），平均每例检出淋巴结1.97枚。SN转移率在肿瘤直径≤2cm组和2.1~4cm组分别是21.43%（9/42）和50.94%(27/53)，两组相比较，随着原发肿瘤的增大SN阳性率相应提高并差异显著（P＜0.01）。SN转移率C erbB 2阴性组为24.32％（9/37），阳性组为46.55％（27/58），两组相比，随着C erbB 2表达增强，SN转移率显著提高并有统计学差异（P＜0.05）。p53, nm23, ER和 PR表达和不表达时影响SN的转移率，但无统计学意义（P＞0.05）。 结论：乳腺癌原发肿瘤大小，C erbB 2表达状态是预测SN转移状态的有用指标。     

乳腺癌分子分型与腋窝淋巴结外科处理

目的探讨乳腺癌分子分型是否影响腋窝淋巴结的术式选择。方法检索有关乳腺癌分子分型与腋窝淋巴结转移情况的文献并进行综述。结果三阴型乳腺癌患者的前哨淋巴结与非前哨淋巴结阳性率均较低,luminalB型和HER-2过表达型患者的腋窝淋巴结转移率较高,尤其是luminalB型乳腺癌患者,其前哨淋巴结阳性率、非前哨淋巴结阳性率均较其他分子分型高,对于行保乳手术的老年患者,当仅有1～2枚前哨淋巴结转移时,可免行腋窝淋巴结清扫;对于肿瘤体积较大的年轻患者,即使前哨淋巴结阴性,非前哨淋巴结阳性的可能性仍然较大,行腋窝淋巴结清扫可能会使这部分患者受益。结论对于腋窝淋巴结的术式选择,乳腺癌分子分型也是需要考虑的因素之一。