Metastasierung beim Mamma - karzinom trotz histologisch negativem Wächterlymphknoten

Summary

The sentinel lymph node (SLN) is of considerable prognostic relevance, because extended lymph node dissection may not be performed in patients presenting with histologically negative SLN. The aim of this study was to prove the prognostic value of the SLN-concept in these patients in long term follow-up. Patients, methods: The clinical follow-up of 202 women with histologically proven breast cancer and metastatically uninvolved (negative) SLN, as determined using Tc- 99m-nanocolloid, was observed for a mean period of 43.4 months. Histological examination included standard methods (HE-Test) and special histochemical techniques (antibodies against cytokeratin). All patients underwent clinical examinations and mamography according a standardised schema; other procedures like ultrasound examination, routine blood tests, and chest X-ray scans were performed in patients considered doubtful after clinical examination or mamography. Results: Despite of negative SLNfindings in 14/202 patients (6.9%) metastases were found after a mean time period of 35.9 months. 4 patients showed local relapses, 3 patients presented with regional lymph node recurrences in the previously mapped (negative) SLN-basin, and 7 Patients developed distant metastases outside the primary lymphatic basin. Conclusion: In patients negative on SLN-biopsy the axillary lymphnode- recurrence-rate was low; in 3/202 patients (1.5%) a progression in the SLN-basin could be assessed, being real concept failures. Our results underline that there is no evidence to question this concept in patients presented with clinically metastatically uninvolved early stage of breast cancer.

Zusammenfassung

Weil der Wächterlymphknoten (SLN) beim Mammakarzinom den Befall nachgeschalteter Lymphknotengruppen reflektiert, erfolgt bei histologisch unauffälligem SLN primär keine regionale Lymphknoten-Dissektion. Ziel dieser klinischen Verlaufsuntersuchung war es, die prognostische Aussage dieses Konzeptes im Langzeit-Verlauf zu prüfen. Patientinnen und Methoden: Der klinische Verlauf von 202 Patientinnen mit gesichertem Mamma-Karzinom und histologisch unauffälliger (negativer) SLN-Exstirpation, detektiert durch 99mTc- Nanocolloid, wurde über einen mittleren Zeitraum von 43,4 Monaten verfolgt. Die histo logische Aufarbeitung umfasste Standardmethoden (HE-Färbung) sowie spezielle immun histochemische Techniken (Zytokeratin- Antikörper-Untersuchung). Alle Patientinnen unterzogen sich klinischen und Mammographie- Untersuchungen nach einem standardisierten Schema; andere Verfahren wie Ultraschall-Untersuchung, Routine-Blut-Teste und Röntgen-Untersuchungen des Thorax wurden bei suspekten klinischen oder Mammo graphie-Befunden durchgeführt. Ergebnisse: Trotz negativem SLN zeigten 14/202 Patientinnen (6,9%) nach einer mittleren Beobachtungszeit von 35,9 Monaten ein Lokalrezidiv und/oder eine Metastasierung. Vier Patientinnen zeigten ein Lokalrezidiv, bei drei Patientinnen konnte eine Lymphknoten- Metastasierung in der (negativen) SLN-Abflussregion gesichert werden und bei 7 Patientinnen entwickelten sich Fernmetastasen außerhalb des zuvor detektierten (negativen) primären Lymph abflussgebietes. Schlussfolgerung: Die axilläre Lymphknoten- Rezidiv-Rate nach negativer SLN-Exstirpation war niedrig; bei 3/202 Patientinnen (1,5%) konnte eine Progression in der SLN-Abflussregion, im Sinne echter Konzeptversager, beobachtet werden. Unsere Daten unterstreichen, dass derzeit keine Notwendigkeit besteht das SLN-Konzept beim präoperativ klinisch nicht metastasierten Frühstadium des Mammakarzinoms in Frage zu stellen.

Keywords

Sentinel lymph node - breast cancer - lymph scintigraphy - intraoperative evaluation - falsenegative

Schlüsselwörter

Wächterlymphknoten - Mammakarzinom - Lymphszintigraphie - intraoperative Evaluation - falsch-negativ

^* Die Patientinnendaten sowie die statistische Auswertung sind Teil der Dissertationsschrift von Frau Melanie Meyer.

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