新辅助化疗后乳腺癌病理变化31例分析

Histopathologic changes of breast cancer following neoadjuvant chemotherapy in locally advanced breast cancer

目的研究乳腺癌新辅助化疗后的病理改变,及其对于预后判断和后续治疗的意义。方法31例局部进展期乳腺癌患者,以TA方案进行新辅助化疗,化疗前的粗针穿刺标本和化疗后的根治术标本均进行病理检测。结果新辅助化疗后,原发病灶与淋巴结出现蜕变坏死、钙化、玻璃样变性、纤维性变等改变;临床体检、B超及钼靶评价新辅助化疗的疗效与病理评价的符合率分别为58.1%、71.0%和51.6%;新辅助化疗后原发肿瘤病理缓解程度高的患者转移淋巴结数目低于病理缓解程度低的患者(P=0.009)。结论①临床评价(体检、超声或钼靶)不能准确体现病灶在新辅助化疗后的变化;②新辅助化疗后原发肿瘤的病理评价可以在一定程度上预测腋窝淋巴结状态。

Objective To investigate pathological changes of breast cancer following neoadjuvant chemotherapy in locally advanced breast cancer. Methods Samples were obtained from 31 patients with locally advanced breast carcinoma who received neoadjuvant chemotherapy, Histopathologic examination was carried out in preoperative core biopsies and the final surgical specimens. Results Various pathologic changes, such as disintegration, necrosis, calcification, hyaline degeneration, and even fibrosis were observed in post- neoadjuvant chemotherapy speci mens. Compared to pathologic examination, the accuracy of clinical, ultrasound and mammography was 58.1%, 71.0% and 51.6%, respectively. The metastasis lymph nodes with was less in patients with good pathological response than those with poor response （P = 0. 009）. Conclusions Clinical evaluation can＇t accurately reflect the pathological response. Pathological response may predict the status of lymph node metastasis in a certain degree.