基于5200多名乳腺癌患者术后生存率分析，研究人员未能发现在手术治疗乳腺癌的过程中，对“哨兵淋巴结（sentinel lymph node，指最接近乳房的那颗淋巴结）”实施活检，并依此确定是否清扫患者的腋窝淋巴结能够延长患者的生存时间。

根据哨兵淋巴结是否存在乳腺癌细胞而确定肿瘤细胞是否已出现远处转移，即是否需要清扫腋窝淋巴结已是多年来手术治疗乳腺癌过程中的常规操作，其结果常常是因为腋窝淋巴结被摘除术（the removal of large numbers of armpit lymph nodes during breast cancer surgery）而易出现上肢水肿，甚至感染与疼痛。

彭博我现在的问题是“假如术中检测哨兵淋巴结并不能够延长乳腺癌患者的生命，那我们还需要坚持这一做法吗”？因为这：一增加了患者的经济负担；二则延长了手术的持续时间；三是增加了并发症机会（如手术同侧上肢水肿等）。更多资讯，请参阅原文：

Lymph Node Test Doesn't Improve Breast Cancer Care, Study Finds

Tiny cancer cells found in first node to which disease typically spreads did not affect survival

TUESDAY, July 26 (HealthDay News) -- A lymph node-sparing test hailed as revolutionary for its conservative approach does not lead to longer survival times for women undergoing lumpectomies whose early-stage breast cancer has spread microscopically, a large, new study suggests.

Examining the medical records of more than 5,200 patients who underwent breast-conserving surgery for early, invasive breast cancer, researchers found that tiny cancer cells in the sentinel lymph node -- the first node to which malignant cells are likely to spread from a primary tumor -- detected with a diagnostic procedure called immunohistochemical (IHC) staining had no effect on overall survival.

The biopsy procedure known as sentinel lymph node (SLN) dissection has been praised for averting the removal of large numbers of armpit lymph nodes during breast cancer surgery, which can lead to a painful buildup of fluid called lymphedema.

"I think I'd have to say it was highly controversial whether these occult [hidden] metastases would be clinically relevant," said study author Dr. Armando Giuliano, chief of surgical oncology at Cedars-Sinai Medical Center in Los Angeles. "If it's not going to affect mortality, it shouldn't affect treatment."

The study is published in the July 27 issue of the Journal of the American Medical Association.

The observational study included data from women included in the American College of Surgeons Oncology Group trial at 126 sites from May 1999 to May 2003, and all patients were followed until April 2010. Results were blinded to treating physicians to avoid the bias of overtreatment, Giuliano said.

At a midpoint follow-up of 6.3 years, 435 women had died and 376 experienced recurrence of their cancer. Based on IHC staining, five-year overall survival rates of those whose samples tested positive for node involvement were 95.1 percent, compared to 95.7 percent for those whose SLN biopsies tested negative. Corresponding five-year rates of disease-free survival were 90.4 percent and 92.2 percent, respectively.

Giuliano said the research, when adopted clinically, can save patients several hundred dollars or more in unnecessary tests. Women with microscopic metastases in their SLNs can also be spared from certain more aggressive treatments that were thought to increase their survival rates, he said.

Dr. Lora Weiselberg, chief of breast cancer service at the Monter Cancer Center of North Shore-LIJ Health System in Lake Success, N.Y., said many physicians have questioned the significance of the SLN biopsies evaluated in the study.

"In certain cases . . . we would want to do them anyway, but otherwise I think this is very strong evidence," Weiselberg said. "I think more and more pathology laboratories are going to go in that direction [of fewer tests] because adding another costly test, if it's not going to help the patient, is unnecessary."

SOURCES: Armando Giuliano, M.D., chief, surgical oncology, and executive vice chair, surgery for surgical oncology, Cedars-Sinai Medical Center, Los Angeles; Lora Weiselberg, M.D., chief, breast cancer service, Monter Cancer Center, North Shore-LIJ Health System, Lake Success, N.Y.; July 27, 2011,Journal of the American Medical Association