图像检测到淋巴结转移的 cN0 患者是否适合进行前哨淋巴结活检 (SLNB)，还是应该直接进行腋窝淋巴结清扫术 (ALND) 或新辅助化疗 (NAC)，目前尚有争议。我们试图确定前期手术需要多久进行 ALND，并确定术前淋巴结 (LN) 活检阳性后与 ≥3 个阳性 SLN 相关的因素。2014 年至 2022 年接受治疗的 cT1-2N0 乳腺癌和 LN 活检阳性患者是从前瞻性数据库中识别出来的。接受 NAC 治疗的患者被排除在外。比较具有 1-2 个阳性 SLN 和 ≥3 个阳性 SLN 的女性的临床病理特征。在 90 名符合条件的患者中，66 例 (73%) 有 1-2 个阳性 SLN，24 例 (27%) 有≥≥3 个阳性 SLN。患者中位年龄为 62 岁，肿瘤大小中位为 2.2 厘米，16 名女性 (18%) 接受了乳房切除术。各组之间的体重指数、肿瘤大小、组织学、分级、多灶性、淋巴血管侵犯的存在和受体状态没有差异。在多变量分析中，≥≥3 个阳性 SLN 与术前影像学检查中≥1 个异常 LN 相关（比值比 [OR] 4.36，95% 置信区间 [CI] 1.47-14.0；p = 0.01），SLN 中显微镜下囊外延伸（ OR 3.83，95% CI 1.25-13.7；p = 0.025），并且去除的 SLN 中位数较高（OR 1.42，95% CI 1.10-1.88；p = 0.01）。超过 70% 的女性患有 cT1-2 乳房具有图像检测到的淋巴结转移的癌症具有 <<3 个阳性 SLN，并且不需要 ALND。为了避免多次前往手术室，对于影像学上有多处异常淋巴结的女性，可以考虑进行冰冻切片。© 2024。外科肿瘤学会。

Whether cN0 patients with image-detected nodal metastases are appropriate for sentinel lymph node biopsy (SLNB) or should proceed directly to axillary lymph node dissection (ALND) or neoadjuvant chemotherapy (NAC) is controversial. We sought to determine how often ALND is needed with upfront surgery and to identify factors associated with ≥ 3 positive SLNs after a positive preoperative lymph node (LN) biopsy.Patients with cT1-2N0 breast cancer and a positive LN biopsy treated from 2014 to 2022 were identified from a prospective database. Patients who received NAC were excluded. Clinicopathologic characteristics were compared between women with 1-2 positive SLNs and ≥ 3 positive SLNs.Of 90 eligible patients, 66 (73%) had 1-2 positive SLNs and 24 (27%) had ≥ 3 positive SLNs. The median patient age was 62 years, median tumor size was 2.2 cm, and 16 women (18%) received a mastectomy. There was no difference in body mass index, tumor size, histology, grade, multifocality, presence of lymphovascular invasion, and receptor status between groups. On multivariable analysis, having ≥ 3 positive SLNs was associated with > 1 abnormal LN on preoperative imaging (odds ratio [OR] 4.36, 95% confidence interval [CI] 1.47-14.0; p = 0.01), microscopic extracapsular extension in the SLNs (OR 3.83, 95% CI 1.25-13.7; p = 0.025), and a higher median number of SLNs removed (OR 1.42, 95% CI 1.10-1.88; p = 0.01).More than 70% of women with cT1-2 breast cancer with image-detected nodal metastases had < 3 positive SLNs and did not require ALND. To avoid multiple trips to the operating room, frozen section can be considered in women with multiple abnormal LNs on imaging.© 2024. Society of Surgical Oncology.