靶向腋窝淋巴结切除在新辅助化疗后腋窝淋巴结评估中的应用

The application of targeted axillary lymph node dissection in the evaluation of axillary lymph nodes after neoadjuvant chemotherapy

目的:探讨靶向腋窝淋巴结切除术(TAD)在评估乳腺癌患者新辅助化疗后腋窝淋巴结转移情况中的应用。方法:前瞻性纳入2015年6月至2020年5月期间丽水市中心医院乳腺疾病诊疗中心收治的行新辅助化疗患者57例,其中31例行新辅助化疗前先在超声引导下将金属标记夹植入经细针穿刺证实转移的腋窝淋巴结,完成化疗后行手术时先在超声引导下对标记淋巴结行穿刺染色定位后行标记的腋窝淋巴结切除,同时行前哨淋巴结活检后再行腋窝淋巴结清扫术(TAD组)。另26例行新辅助化疗后,术中单纯行前哨淋巴结活检后再行腋窝淋巴结清扫术(对照组),比较两组前哨淋巴结检出率、准确率、灵敏度及假阴性率。结果:57例患者中至少检出1枚前哨淋巴结者有53例,前哨淋巴结检出率为92.98%,其中TAD组31例,对照组26例。TAD组淋巴结检出率为100%(31/31),灵敏度为94.44%(17/18),假阴性率为5.56%(1/18),准确率为96.77%(30/31)。对照组淋巴结检出率为84.62%(22/26),灵敏度为62.50%(10/16),假阴性率为37.50%(6/16),准确率为72.73%(16/22)。TAD组的淋巴结检出率、灵敏度及准确率明显高于对照组(P<0.05);TAD组假阴性率明显低于对照组(P<0.05)。结论:腋窝淋巴结阳性的乳腺癌患者新辅助化疗后行TAD联合前哨淋巴结活检相较于单纯行前哨淋巴结活检更能真实反映腋窝淋巴结转移情况。

Objective:To explore the application of targeted axillary lymph node resection in the assessment of residual axillary lymph node metastasis in breast cancer patients after neoadjuvant chemotherapy.Methods:Totally 57 patients who were admitted to the Breast Disease Diagnosis and Treatment Center of Lishui Central Hospital and underwent neoadjuvant chemotherapy from June 2015 to May 2020 were prospectively errolled in this study.In 31 patients undergoing neoadjuvant chemotherapy,the marker clip was implanted into the metastatic axillary lymph node,confirmed by fine needle aspiration under ultrasound guidance.After chemotherapy,the labeled lymph node was punctured and stained under ultrasound guidance and then sentinel lymph node biopsy was performed at the same time as the marker removal of axillary lymph nodes(TAD),and then axillary lymph node was dissected(for TAD group).The remaining 26 cases received neoadjuvant chemotherapy alone.After the chemotherapy was completed,sentinel lymph node biopsy was performed and then axillary lymph node was dissected(for the control group).Statistical analysis was made of the lymph node detection rate,accuracy,sensitivity and false negative rate of targeted axillary lymph node resection and sentinel lymph node biopsy.Results:Among 57 patients,at least one sentinel lymph node was detected in 53 cases.The detection rate of SLN was 92.98%.Among them,31 cases were in the TAD group and 26 cases were in the control group.The detection rate of lymph nodes in the TAD group was 100.00%(31/31),with the average number of lymph nodes being 3.39 per case,the sensitivity 94.44%(17/18),the false negative rate 5.56%(1/18),and the accuracy rate 96.77%(30/31).The detection rate of lymph nodes in the control group was 84.62%(22/26),with the average number of lymph nodes detected being 3.38 per case,the sensitivity 62.50%(10/16),the false negative rate 37.50%(6/16),and the accuracy rate 72.73%(16/22).The detection rate,sensitivity and accuracy of lymph nodes in the TAD group were significantly higher than those of the control group,which showed statistical differences(P<0.05),and the false negative rate of the TAD group was significantly lower than that of the control group,with statistical differences(P<0.05).Conclusion:Targeted axillary lymph node dissection for breast cancer patients after neoadjuvant chemotherapy can actually reflect the axillary lymph node metastasis,compared with sentinel lymph node biopsy alone.