乳腺癌新辅助化疗后前哨淋巴结活检意义的前瞻性研究

Prospective study of axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer

目的:探讨乳腺癌患者新辅助化疗(NAC)后腋窝前哨淋巴结活检的可行性。方法:采用99Tc硫胶体联合亚甲蓝示踪法对60例NAC后达到临床腋淋巴结阴性的乳腺癌患者和60例临床腋淋巴结阴性的早期乳腺癌患者进行腋窝前哨淋巴结活检术(SLNB),评估SLNB的检出率和准确性,比较两组患者SLNB的检出率和假阴性率,并分析NAC后SLNB检出率和假阴性率与患者及肿瘤特点的关系。结果:60例NAC后患者的前哨淋巴结(SLN)检出率为90%,SLNB的敏感度为90%,特异度为93.33%,准确性为91.67%,假阴性率为10%。其检出率和假阴性率与早期乳腺癌组比较,差异均无统计学意义(P=0.743,P=1.000)。NAC组化疗前临床分期T3或N2以上者,腋淋巴结的检出率均显著下降,差异有统计学意义(P=0.030,P=0.000),分期N2以上者假阴性率显著增高,差异有统计学意义,P=0.001。结论:对NAC后达到临床淋巴结阴性的乳腺癌患者,腋窝SLN的检出率和假阴性率与早期乳腺癌SLNB差异无统计学意义,化疗前的TN分期是SLNB检出率和假阴性影响因素。

OBJECTIVE：To evaluate the feasibility of axillary sentinel lymph node biopsy （SLNB） after neoadjuvant chemotherapy （NAC） for breast cancer. METHODS：SLNB was performed by using a combination of 99Tc-sulfur colloid and methylene blue in 60 breast cancer patients with clinical negative axillary nodes after NAC and 60 early breast cancer patients with clinical negative axillary nodes. The identification rate,accuracy,and false negative rate of SLNB were evaluated. The correlation between the identification rate,false negative rate of SLNB and the patients and tumor characteristics was also analyzed. RESULTS：The identification rate of SLNB after NAC was 90%. The sensitivity,specificity,accuracy,and false negative rate were 90%,93.33%,91.67% and 10% respectively. The identification rate and false negative rate in the breast cancer patients with clinical negative axillary nodes after NAC were not significantly different from those in the early breast cancer patients with clinical negative axillary nodes （P=0.743,P=1.000）. In the NAC group,the identification rate in the cases of T3 stage were lower than that in T1-2 stage significantly （P=0.030）,and in N2 stage were lower than N0-1 stage （P=0.000）. However the false negative rate in the N2 stage was significantly more than that in the N0-1 stage （P=0.001）. CONCLUSIONS：The identification rate and false negative rate of axillary sentinel lymph nodes in the breast cancer patents with clinical negative axillary node after NAC were similar to those in the patiedts who achieved in early-stage breast cancer. TN stage is a predictor to the identification rate and false negative rate of SLNB in the breast cancer patents after NAC.