目的

探讨早期浸润性乳腺癌（cT_1-2N_0-1M₀）保留乳房（简称保乳）患者的腋窝分期策略。

方法

根据纳入及排除标准，纳入2016年1月至2023年9月北京大学国际医院乳腺外科收治的701例早期浸润性乳腺癌（cT_1-2N_0-1M₀）保乳患者进行回顾性研究。对患者腋窝淋巴结（ALN）进行超声评估，cN₁患者优选超声引导细针穿刺活组织检查（FNAB）；cN₀或cN₁且FNAB阴性患者，则接受前哨淋巴结活组织检查（SLNB）。如患者SLN有1～2枚转移，则豁免腋窝淋巴结清扫（ALND）；如患者SLN≥3枚转移，则需接受ALND。cN₁且FNAB阳性患者［cN_1（f）］，则需接受ALND。

结果

701例患者中，539例（76.9%）cN₀患者接受SLNB，162例（23.1%）cN₁患者接受超声引导FNAB，其中105例（64.8%）患者FNAB阴性并接受后续SLNB，57例（35.2%）患者FNAB阳性并接受ALND。该57例cN_1（f）患者ALND术后病理证实，49例（86.0%）患者ALN仅有1～2枚转移，如果优选SLNB，则可以豁免ALND。644例患者（包含539例cN₀和105例cN₁且FNAB阴性患者）接受SLNB，结果显示519例（80.6%）患者SLN阴性无需后续ALND；113例（17.5%）患者SLN有1～2枚转移，豁免ALND。超声评估cN_0-1患者ALN的敏感度仅为47.3%（86/182），误诊率达14.6%（76/519）。

结论

对于早期浸润性乳腺癌保乳患者，超声检查对腋窝分期不敏感。如cT_1-2N_0-1M₀患者腋窝分期全部优选SLNB，既简化了分期流程，又能进一步提高其中cN_1（f）患者保留腋窝淋巴结的比率。

Objective

Toexplorethestrategyofaxillarystaginginbreast-conservingpatientswith early invasive breast cancer （cT_1-2N_0-1M₀）.

Methods

A-ccording to the inclusion and exclusion criteria， a total of 701 breast-conserving patients with early invasive breast cancer （cT_1-2N_0-1M₀） in the Department of Breast Surgery， Peking University International Hospital from January 2016 to September 2023 were included for a retrospective study. Ultrasound examination of axillary lymph node （ALN） was performed in 701 patients.Ultrasound-guided fine-needle aspiration biopsy （FNAB） was performed in cN₁ patients. The cN₀ patients or cN₁ patients with negative results of FNAB underwent sentinel lymph node biopsy （SLNB）. Patients with 1-2 positive sentinel lymph nodes （SLNs） were exempted from axillary lymph node dissection （ALND）. Patients with ≥3 positive SLNs underwent ALND. cN₁ patients with positive results of FNAB ［cN_1（f）］underwent ALND.

Results

Among these 701 patients （cT_1-2N_0-1M₀）， 539 cN₀ patients （76.9%） underwent SLNB and 162 cN₁ patients （23.1%） underwent ultrasound-guided FNAB. The 105 （64.8%） patients with negative results of FNAB underwent SLNB， and 57 （35.2%） patients with positive results of FNAB underwent ALND.Among these 57 cN_1（f） patients， 49 patients （86.0%） had 1-2 positive ALNs confirmed by postoperative pathology and could not have undergone ALND if SLNB was performed preferentially. Totally 644 patients （539 cN₀ patients and 105 cN₁ patients with negative findings in FNAB） underwent SLNB. The results of SLNB showed that 519 （80.6%） patients with negative SLN did not require subsequent ALND， and 113 （17.5%）patients with 1-2 positive SLNs were exempted from ALND. The sensitivity of ultrasonography in detecting ALNs of cN_0-1 patients was 47.3% （86/182）， and the misdiagnosis rate was 14.6% （76/519）.

Conclusion

The ultrasonography is not sensitive enough for axillary staging in cT_1-2N_0-1M₀ breast cancer patients. SLNB is suggested to be performed preferentially for axillary staging， which can not only simplify the staging process，but also further improve the ALN-preservation rate in cN_1（f） patients.