染料法前哨淋巴结活检在乳腺癌新辅助化疗后的临床意义

Sentinel lymph node biopsy with methylene blue after neoadjuvant chemotherapy for breast cancer

目的:探讨乳腺癌新辅助化疗后行染料法前哨淋巴结活检的可行性、有效性及准确性。方法:对2007年5月至2011年4月期间41例广州医学院第一附属医院乳腺外科确诊为乳腺癌的患者(Ⅱ期或Ⅲ期)予2～4个疗程新辅助化疗后,行患侧亚甲蓝示踪前哨淋巴结活检+乳腺癌改良根治术或联合腋窝淋巴结(Ⅰ-Ⅱ/Ⅲ级)清扫的乳腺癌保乳术。结果:在Ⅰ级腋窝淋巴结中检出前哨淋巴结39例,每例平均前哨淋巴结及腋窝淋巴结的检出数目分别为1.5±0.2枚和17±5枚。前哨淋巴结的检出率、准确率、灵敏度,假阴性率分别为95.1%、92.3%、88.0%、12.0%,以上各指标与新辅助化疗前患者的原发肿瘤大小、区域淋巴结分级、TNM分期、年龄,或者体重指数之间无相关性(P>0.05)。结论:对于部分行新辅助化疗后的乳腺癌患者,亚甲蓝示踪前哨淋巴结活检是安全可行的,且能较准确预测腋窝淋巴结的状况。

Objective： To evaluate the feasibility, efficacy and accuracy of sentinel lymph node biopsy （ SLNB ） with methylene blue after neoadjuvant chemotherapy （ NAC ） in patients with breast cancer. Methods： A total of 41 breast cancer patients （ stage Ⅱ or Ⅲ ） admitted to Department of Breast Surgery, First Affiliated Hospital of Guangzhou Medical College, between May 2007 and April 2011, received two to four cycles of NAC. They then underwent SLNB （using methylene blue） , followed by either modified radical mastectomy or breast- sparing conservative surgery with complete axillary lymph node dissection （ levels Ⅰ - Ⅱ /Ⅲ ）. Results： 39 cases were found to have sentinel lymph nodes （SLNs） among level I axillary lymph nodes, with a mean of 1.5 ±0. 2 SLNs and 17 ±5 axillary lymph nodes resected in each case. The SLN detection rate, accuracy, sensitivity and false-negative rate were 95.1% ,92.3% ,88.0% and 12.0% respectively,which were not correlated with the size of primary tumor, level of regional lymph nodes ,TNM staging, age, or body mass index before NAC （P 〉 0.05 ）. Conclusion：This study confirms that SLNB with methylene blue after NAC is safe, feasible and accurate for evaluating axillary lymph nodes in certain patients with breast cancer.