乳腺癌患者新辅助化疗后行前哨淋巴结活检可行性的系统评价

Feasibility of sentinel lymph node biopsy in breast cancer patients following neoadjuvant chemotherapy:a systematic analysis

目的评价乳腺癌患者在新辅助化疗（NCT）后行前哨淋巴结活检术（SLNB）可行性。方法以＂乳腺癌＂、＂新辅助化疗＂及＂前哨淋巴结活检＂为自由词和主题词于中国生物医学文摘数据库（CBM）和PubMed、Medline及Embase数据库进行文献检索。按照严格的纳入、排除标准对所获得文献进行筛选。根据NCT前腋窝淋巴结状况分为腋窝淋巴结阴性组和腋窝淋巴结阳性组。对纳入文献记录提取必要数据后,使用STATA软件将各项研究结果合并后计算前哨淋巴结检出率及假阴性率。结果共纳入41项原创性研究,共计5 848例患者。腋窝淋巴结阴性组患者2 050例,其中1 891例成功检出前哨淋巴结,检出率为0.94（95%CI 0.92~0.96）,假阴性率为0.07（95%CI 0.04~0.10）。腋窝淋巴结阳性组患者3 798例,3 059例成功检出前哨淋巴结,检出率为0.87（95%CI 0.84~0.90）,假阴性率为0.13（95%CI 0.11~0.16）。结论 NCT前腋窝淋巴结阴性的乳腺癌患者可在NCT后行SLNB,NCT前腋窝淋巴结阳性患者则不建议NCT后行SLNB。

Objective To evaluate whether sentinel lymph node biopsy（SLNB）can be used in breast cancer patients following neoadjuvant chemotherapy （NCT） by systematically reviewing the published literatures. Methods The databases CBM, PubMed, Medline and Embase were searched using ＂breast cancer＂, ＂neoadjuvant chemotherapy＂ and ＂sentinel lymph node biopsy＂ as free words and MeSH terms for related literatures. The papers were selected strictly in accordance with the inclusion and exclusion criteria. The studies were divided into axillary lymph node-negative group and axillary lymph node- positive group according to the status of axillary lymph node before NCT. The data of the included researches were extracted and were then merged using STATA to estimate the identification rate and false-negative rate of SLNB in this setting. Results Forty-one studies were identified which involving a total of 5 848 patients. Lymph node-negative group contained 2 050 patients, and 1 891 of them were successfully detected in more than one sentinel lymph node, with the detecting rate and the false negative rate being 0. 94 （95~/oo CI -- 0. 92 0.96） and 0. 07 （95% CI = 0. 04-0. 10）, respectively. Lymph node-positive group contained 3 798 patients, and 3 059 of them were successfully detected in more than one sentinel lymph node, with the detecting rate and false-negative rate being 0. 87 （95% CI = 0. 84-0. 90） and 0. 13 （95% CI = 0. 11-0. 16）, respectively. Conclusion SLNB is reliable for women with lymph node-negative breast cancer receiving neoadjuvant chemotherapy. But it is not recommended for those with lymph node-positive breast cancer.