Abstract:
Objective
Toexplorethestrategyofaxillarystaginginbreast-conservingpatientswith early invasive breast cancer （cT1-2N0-1M0）.
Methods
A-ccording to the inclusion and exclusion criteria， a total of 701 breast-conserving patients with early invasive breast cancer （cT1-2N0-1M0） 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 ［cN1（f）］underwent ALND.
Results
Among these 701 patients （cT1-2N0-1M0）， 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 cN1（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 cN0-1 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 cT1-2N0-1M0 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 cN1（f） patients.
Key words:
Breast neoplasms,
Axillary staging,
Biopsy， fine needle,
Sentinel lymph node biopsy,
Axillary lymph node dissection
Guofeng Zhang, Xiangsheng Xu, Lei Liu, Chun Zhang, Lei Kong, Lizhu Fang. Axilla staging in breast-conserving patients with early invasive breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(02): 92-96.