Vergleichende Wertung von Mikro- und Makrometastasen in axillären Sentinel- und non-Sentinel Lymphknoten bei Frauen mit Mammakarzinom

Breast cancer is, as the most common tumor disease, a big challenge for diagnosticians and therapists. Many scientific efforts were made to evaluate the prediction with mathematic analyses called nomograms. In this dissertation we compare the axillary micro- and makrometastases in sentinel and non-sentinel lymph nodes in women with breast cancer. Till now the description of the metastasis size of axillary lymph nodes is not include in the nomograms of today. It could be possible to improve existing nomograms by using the following results. Therefore we analyzed 599 patients with primary carcinoma of the mamma. In the age from 36-49 years we find significant higher rates of SLN with micrometastases when positive estrogen receptors could be found and when primary cancer staged pT1b and/or G2. The frequency of micrometatasis in the SLN rises till the staging pT1c, than it is replaced by axillary makrometastases. The less frequent breast cancer of the lobular type in grading G2 shows the highest chance for a further finding of micrometastases in the SLN. More micrometastases could be found in G1 and G2 tumors compared to G3 tumors, here is a higher confidence of makrometastases. An essential notice is the massage, the bigger the size of the metastases, the higher the risk for further metastases in non-SLN lymph nodes. The risk of further metastases after micrometastases is 17%, compared to 47% after makrometastases. Studies about axillary dissection after positive SLN are still heterogenic. On one hand studies focused the frequency of metastases after positive SLN and residues in aftercare. The conclusion here is, radiation after breast conserving therapy in cases with two or less lymphatic metastases is sufficient and axillary dissection is not necessary. In contrast groups focused the axillary dissection after molecular analyses. In the future there will be more results by actual running studies and adaptive therapies could be developed. Nomograms could be developed by using the grading and histology from different types of cancer to invent individual therapies. Especially analyses of the metastases size in axillary SLN in primary carcinoma of the mamma should be recognized and involved in new models of nomograms, although the impact of survival and disease-free survival in literature seems small.