乳腺癌前哨淋巴结活检假阴性率的单中心多因素分析

Analysis of clinicopathological factors associated with false-negative rate of sentinel lymph nodebiopsy in breast cancer patients： experience of a single center

目的分析影响乳腺癌前哨淋巴结活检（SLNB）假阴性的临床病理学因素，探讨降低SLNB假阴性率的措施与方法。方法回顾性分析接受SLNB的2265例乳腺癌患者临床病理资料，对SLNB后接受腋窝淋巴结清除（ALND）的1228例患者进行分析，研究临床病理因素与SLNB假阴性率的相关性。结果SLNB的假阴性率为10．7％（73／683），准确率为94．1％（1155／1228），阴性预测值为88．2％（545／618）。单因素分析显示，SLNB假阴性率与肿瘤大小（P=0．030）、前哨淋巴结（SLN）检出数目（P〈0．001）和手术年份（P=0．001）有关，SLNB准确率与肿瘤大小（P=0．003）、SLN检出数目（P=0．003）和手术年份（P=0．015）有关。多因素分析显示，手术年份（P=0．034）和SLN检出数目（P=0．012）为SLNB假阴性率的独立影响因素。结论乳腺癌SLNB假阴性率与SLN检出数目和手术年份有关。严格人选指征、规范操作标准以及提高外科医生操作熟练程度是降低SLNB假阴性率的有效措施。

Objective The purpose of this study was to investigate the clinicopathologic factors associated with false-negative rate of sentinel lymph node biopsy （SLNB） in breast cancer, and to explore how to reduce the false-negative rate of SLNB. Methods The elinicopathologieal data of 2265 patients with invasive breast carcinoma who underwent sentinel lymph nodes biopsy （SLNB） in Shandong Cancer Hospital between November 1999 and December 2011 were retrospectively analyzed. We screened 1228 patients who received axillary lymph node dissection after SLNB, and studied the clinicopathologieal factors that could be associated with false-negative rate of SLNB. Results The false negative rate of this group was 10.7% （73/683）, accuracy rate was 94. 1% （1155/1228）, and negative predictive value was 88.2% （545/618）. Clinical tumor size （ all P 〈 0.05 ）, calendar year of surgery （ all P 〈 0.05 ） and numbers of detected SLNs （ all P 〈 0.05 ） were significantly related with false negative rate and accuracy rate of SLNB, determined by single factor analysis. Logistic regression model analysis showed that calendar year of surgery （ P = 0.034 ） and numbers of detected SLNs （P = 0.012） were independent predictive factors for the false negative rate of SLNB. Conclusions False negative rate and accuracy rate of SLNB are significantly related to the calendar year of surgery and number of detected SLNs. Strict case selection, standard operation procedure, increaseing numbers of detected SLNs, and improvement of the skill of operators are effective measures to reduce the false negative rate of SLNB.