新辅助化疗后乳腺癌患者前哨淋巴结活检的可行性评价

Evaluation on feasibility of sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

目的:分析新辅助化疗(NAC)后乳腺癌患者前哨淋巴结(SLN)转移和腋窝淋巴结清扫(ALND)转移情况,探讨前哨淋巴结活检(SLNB)在NAC后乳腺癌患者中的应用价值。方法:收集完成NAC后行SLNB并行ALND的乳腺癌患者52例,选取未接受NAC行SLNB并行ALND的乳腺癌患者35例,采用99mTc硫胶体联合亚甲蓝示踪前哨淋巴结(SLN)并切除,常规清扫腋窝淋巴结(ALN)。术后对SLNB和ALND的病理结果进行比较分析。结果:52例接受NAC患者均检出至少1枚SLN,检出率为100%,检出SLN共计113枚,NAC后行SLNB的准确率为94.2%,假阴性率为8.1%,灵敏度为91.9%,特异性为100%,阳性预测值为100%,阴性预测值为83.3%。35例未接受NAC患者均检出至少1枚SLN,检出率为100%,检出SLN共计73枚,未接受NAC患者行SLNB的准确率为94.3%,假阴性率为7.1%,灵敏度为92.8%,特异性为100%,阳性预测值为100%,阴性预测值为77.8%。结论:NAC后的SLNB有可能逐渐取代ALND成为NAC后淋巴结阴性患者淋巴结处理的标准方法。

Objective To analyze the sentinel lymph node metastasis in the breast cancer patients after neoadjuvant chemotherapy（NAC）and axillary lymph node dissection（ALND）,and to investigate the application value of sentinel lymph node biopsy（SLNB）in the breast cancer patients after NAC.Methods 52breast cancer patients after NAC and 35non-NAC breast cancer patients were selected.All of the patients accept SLNB and ALND and received a subareolar injection of 99mTechnetium（Tc）labeled unfiltered sulfur colloid.The sentinel lymph node was detected by agamma probe during the operations.Then the conventional ALND were performed.All of the sentinel lymph nodes and axillary lymph nodes were sent for pathological examination.Results A total of113sentinel lymph nodes were detected after NAC in 52breast cancer patients,the successful identification rate was 100%.The accuracy,false negative rate,sensitivity,specificity,positive predictive value and negative predictive value of SLNB in the breast cancer patients after NAC were 94.2%,8.1%,91.9%,100%,100%,and 83.3%,respectively.A total of 73sentinel lymph nodes were detected in 35non-NAC patients,the successful identification rate was 100%.The accuracy,false negative rate,sensitivity,specificity,positive predictive value and negative predictive value of SLNB in the breast cancer patients after NAC were 94.3%,7.1%,92.8%,100%,100%,and 77.8%,respectively.Conclusion SLNB after NAC may gradually replace ALND as the standard treatment for lymph node negative patients after NAC treatment.