乳腺癌肿块切除对腋窝淋巴结状态的影响

The influence of lumpectomy on the axillary lymph node status of breast cancer patients

目的探讨乳腺癌肿块切除对腋窝淋巴结状态的影响。方法回顾性分析河南省肿瘤医院2011年11月至2013年8月腋窝触诊阴性、行前哨淋巴结（SLN）活检的738例浸润性乳腺癌的临床资料。136例患者术前在外院行乳腺癌肿块切除术（肿块切除组），602例患者术前未行肿块切除术而是经穿刺活检证实（穿刺活检组），比较两组患者彩超下腋窝淋巴结状态和SLN阳性率的差异。结果738例患者中，444例（60．2％）患者彩超下腋窝淋巴结可见，其中肿块切除组和穿刺活检组分别为92例和352例，差异有统计学意义（P=0．048）。彩超下腋窝淋巴结可见患者中，肿块切除组和穿刺活检组患者腋窝最大淋巴结〉1cm者所占比例分别为58．7％（54／92）和52．8％（186／352），差异无统计学意义（P=0．316）；腋窝最大淋巴结长径与短径比值〉2者所占比例分别为37．0％（34／92）和38．6％（136／352），差异无统计学意义（P=0．768）。肿块切除组和穿刺活检组患者的SLN阳性率分别为23．5％（32／136）和26．9％（162／602），差异无统计学意义（P=0．419）。肿块切除时间≤7d和〉7d患者腋窝可见淋巴结的发生率分别为71．1％（64／90）和60．9％（28／46），差异无统计学意义（P=0．227）；SLN阳性率分别为28．9％（26／90）和13．0％（6／46），差异有统计学意义（P=0．039）。彩超可见腋窝淋巴结、腋窝最大淋巴结长径和长径与短径比值〈2与SLN阳性率均有关（均P〈0．05）。结论乳腺癌肿块切除术后，彩超下可见腋窝淋巴结的发生率更高。对于肿块切除至彩超检查时间较长的患者，即使彩超下可见腋窝淋巴结，其SLN阳性率也较低。

Objective To investigate the influence of lumpectomy on axillary lymph node status of breast cancer patients. Methods The clinical data of 738 invasive breast cancer patients with non-palpable axillary lymph node and sentinel lymph node （SLN） biopsy from November 2011 to August 2013 in Henan Provincial Cancer Hospital were collected and retrospectively analyzed. Among them, 136 patients underwent preoperative lumpectomy （lumpectomy group ） and 602 patients underwent puncture biopsy only （biopsy group）. The difference of axillary lymph node status and positive ratio of SLN detected by color Doppler ultrasound were compared between these two groups. Results Among the 738 breast cancer patients, the axitlaly lymph nodes of 444 （ 60.2% ） cases could be detected by uhrasound. Among them, 92 cases belonged to lumpectomy group, significantly less than 352 cases of biopsy group （P=0.048）. Among the patients with uhrasound-visible lymph nodes, the proportion of the biggest diameter of axillary lymph node 〉 1 cm of lumpectomy group or biopsy group was 58.7% （54/92） or 52.8% （ 186/352）, respectively, without significant difference （P= 0.316）. The proportion of patients with the ratio of long diameter to short diameter 〈2 of lumpectomy group or biopsy group was 37.0% （34/92） or 38.6% （136/352） , respectively, with marginal difference （P= 0.768）. The positive rate of SLN of lumpectomy group or biopsy group was 23.5% （32/136） or 26.9% （162/602） , respectively, without significant difference （ P = 0.419）. The incidence rate of the ultrasound visible axillary lymph nodes of patients whose postoperative time ≤ 7 days or 〉 7days was 71.1% （64/90） or 60.9% （ 8/46）, respectively, without significant difference （P= 0.227）. However, the positive rate of SLN of these two groups was 28.9% （26/90） and 13.0% （6/46）, respectively, with significant difference （P = 0. 039 ）. The number of ultrasound visible axillary lymph nodes, the biggest diameter of axillary lymph nodes and the ratio of the long diameter to short diameter 〈 2 were substantially correlated with the positive rate of SLN （P〈0.05）. Conclusions The incidence rate of ultrasound visible axillary lymph node in the patients with lumpectomy is higher than that of patients with puncture biopsy only. The positive rate of SLN of the patients with a long postoperative time is lower than that of patients with a short postoperative time, even though the axillary lymph nodes are uhrasound visible.