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Il Giornale di Chirurgia

Studio di fattori predittivi di metastatizzazione nei linfonodi ascellari non sentinella in pazienti con biopsia del linfonodo sentinella positiva

Articolo, 13 - 15
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In the last 20 years the research about breast cancer have had a great acceleration, and the development of sophisticate diagnostic instruments allowed the planning of screening campaign with the result of a rapid increment of small dimensioned lesions or pre-clinic lesions finding.
In accord with the literature it is accepted that the lymph nodal status is one of the most important survival prognostic factors for breast cancer axillary recurrence, with the tumour size, the grade and receptors status.
In the last decade, sentinel lymph node biopsy has became an important instrument to determine the axillary lymph node involvement in patients with breast cancer because this is a minimally invasive technique with an elevated prognostic significance and allow to appoint an accurate disease staging (1-3).
Because of this, the sentinel lymph node biopsy is proposed as valid alternative to the axillary lymphadenectomy: this is performed only when the histological exam of the sentinel lymph node is positive for metastatic disease.
However in literature it is reported that the incidence of non - sentinel (NSN) lymph node metastases in patients with a tumour – positive sentinel lymph node varies greatly from 20-70% (4-6), and there are several publications in literature about the sentinel lymph node technique in which it remains an high negativity (69-86%) (7) to the control at complementary lymph node dissection also when sentinel lymph node was positive. Since sentinel lymph node is in these cases the only positive lymph node, the removal of further lymph nodes does not give a greater benefit.
The aim of this study was to evaluate molecular and histological factors to improve the surgical treatment of the axilla in patients with T1 breast cancer and positive Sentinel Lymph node.
In this study we obtained data that lead us to avoid further unnecessary axillary dissections, using only instrumental follow-up protocols when the lesions are smaller that 1 cm, with sentinel lymph node positive only for micrometastasis and in absence of lymphovascular invasion.

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