乳腺癌前哨淋巴结活检假阴性相关因素的分析

Analysis of false negative correlation factors of sentinel lymph node biopsy in breast cancer

目的分析乳腺癌前哨淋巴结活检假阴性率的相关临床病理因素,探讨如何降低乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)的假阴性。方法回顾性分析2012年1月至2015年12月山东省肿瘤医院645例乳腺癌并腋窝淋巴结清扫的临体资料。采用Log-rank行单因素分析,Cox比例风险模型行多因素分析。结果 645例中真阳性、真阴性及假阴性分别为59.4%、33.3%及9.2%。在所有假阴性病例中92.3%患者腋窝阳性淋巴结出现在Ⅰ和(或)Ⅱ水平。阴性预测值为96.4%,准确率为92.7%。单因素分析显示前哨淋巴结FN与ER表达、PR表达、HER2表达、分子分型及阳性淋巴结数目有关(均P<0.05),而发病年龄、是否绝经、Ki-67表达、SLN检测方法及肿瘤大小在FN组及TP组无明显差异(均P>0.05)。其中ER表达(OR=0.303,P<0.05)、HER2表达(OR=9.594,P<0.05)以及阳性腋窝淋巴结数目(OR=0.409,P<0.05)是假阴性的独立影响因素。结论对于ER阴性、PR阴性及HER2阳性的高危乳腺癌,术中清扫Ⅰ和(或)Ⅱ水平淋巴结可能更安全。

Objective To analyze the clinical and pathological factors of false negative rate of sentinel lymph node biopsy in breast cancer, and to explore how to reduce false negative of lymph node biopsy SLNB （sentinel） of breast cancer sentinel lymph node biopsy. Methods A retrospective analysis was made on 645 cases of breast cancer and axillary lymph node dissection in Shandong Provincial Cancer Hospital from January 2012 to December 2015, using Log-rank to carry on the single factor analysis, the Cox proportional hazard model carries on the muhi factor analysis. Results Among 645 cases of breast cancer, positive, true negative and false negative were 59.4%, 33.3% and 9.2% respectively. Positive axillary lymph nodes were found in 92. 3% of all false negative cases. The negative predictive value was 96.4% and the accuracy was 92. 7%. Single factor analysis showed that： sentinel lymph node FN with the expression of Er, PR, HER2, molecular type and positive lymph node is related to the number （ P 〈 0.05 ） , and age of onset, whether menopause, Ki- 67 expression and SLN detection method and the size of tumor in the FN group and TP group no significant difference （P 〉 0. 05 ）. ER expression （ OR = 0. 303, P 〈 0. 05 ）, HER2 expression （ OR = 9. 594, P 〈 0. 05 ） and positive axillary lymph node number （ OR = 0. 409, P 〈 0.05 ） are false negative independent influ-ence factors. Conclusions For the patients with ER negative, PR negative and HER2 positive breast cancer, it may be a safe measure to clean the level of Ⅰ and / or Ⅱ lymph nodes during surgery.