目前早期乳腺癌进行前哨淋巴结活检是公认的腋窝局部处理方式，对于腋下前哨淋巴结阴性的患者可以避免腋清扫，而对于腋下前哨淋巴结阳性的患者尚存争议。根据Z0011和ABCSG23-01研究，符合条件的患者即便前哨淋巴结阳性也可以避免腋窝淋巴结清扫，但不可否认的是检测全部淋巴结阳性的数目对后续的分期及辅助治疗的决策会产生影响。目前世界范围内一些乳腺癌中心建立自己的模型，预测非前哨淋巴结转移的比例，以此推断更为准确的疾病分期，指导腋窝的局部处理和辅助治疗。

　　在今年荷兰进行的EBCC大会上，日本学者T.Kinoshita将在3月10日发表他们自己的模型研究（043. Study of axillary lymph node staging based on a combined use of histology and one-step nucleic acid amplification method for breast cancer patients without axillary lymph node dissection）。研究共入组1176例cTis-3N0患者，323例因前哨淋巴结阳性进行了腋窝淋巴结清扫，在前哨淋巴结活检中选用传统的组织学检测和分子水平的一步核酸扩增法相结合，根据不同分级进行评分，对非前哨淋巴结转移进行预测。同时检测一步核酸扩增法对N2淋巴结的相关性，并利用模型对临床预后进行预测评估。所得结果与传统临床病理学因子相比较，更为准确预测非前哨淋巴结转移和转移淋巴结的数目，并与患者的RFS相关。该研究亮点是采用了分子水平检测前哨淋巴结，并与组织学检查相结合，为早期乳腺癌淋巴结活检提供新的思路，值得期待。

　　专家简介

　　郭宝良

　　主任医师、教授，哈医大附属二院乳腺科，中国抗癌协会乳腺癌专业委员会青年委员、中国医师协会乳腺疾病培训专家委员会委员、中国医药教育学会乳腺疾病专业委员会委员、中国医师协会外科学分会MDT专业委员会委员。

　　研究摘要

Study of axillary lymph node staging based on a combined use of histology and one-step nucleic acid amplification method for breast cancer patients without axillary lymph node dissection

Poster Spotlight: T. Kinoshita (Japan)

Background: We developed the NCS score based on detailed evaluation of SLNs in breast cancer patients by a combined use of histology and OSNA， to determine breast cancer patients in whom ALND can be omitted. ACOSOG Z0011 study revealed that ALND can be omitted in selected breast cancer patients even when they are positive for SLN metastasis. However， determining the total number of axillary lymph nodes， or staging， is still important when deciding postoperative treatment strategy.

Material and Methods: There were 1176 cTis-3?N0 patients who were operated in our institution and diagnosed by a combined use of histology and OSNA for SLNs. Of these， 323 patients who underwent additional ALND for positive SLN metastases were included in this study. SLNs evaluated as MAC， MIC， and ITC in histology and evaluated as 2+， 1+， and +I in OSNA and they were assigned with 3， 2， and 1 points， respectively. In each patient， the total sum of histology and OSNA points of all SLNs was defined as a NCS score point. We compared the performances of NCS score and other clinical factors on predicting the total number of lymph node metastases (N2 staging) and RFS rates.

Results: Performances of NSC score on predicting non-SLN metastases and N2 staging (AUC=0.912 and 0.920， respectively) were better than those of other individual factors. Our data suggested that semiquantitative OSNA was a prognostic factor independent of pathology for N2 staging (OR=4.90， P<0.0001). NSC score and OSNA copy number were both significantly correlated with RFS.

Conclusion: NCS score is a good independent prognostic factor for predicting not only non-SLN metastases but also the number of lymph node metastases.