乳腺癌新辅助化疗后前哨淋巴结活检的临床价值

Clinical Value of Sentinel Lymph Node Biopsy in Breast Cancer Patients After Neoadjuvant Chemotherapy

目的探讨乳腺癌新辅助化疗(NAC)后行前哨淋巴结活检(SLNB)的临床价值。方法选择荆州市中心医院乳腺科2017年1月至2019年12月经病理确诊的130例原发性乳腺癌(cT_(1-3)N_(0-2)M_(0)),根据腋窝淋巴结状态将患者分为观察组和对照组,观察组(70例)为腋窝淋巴结阳性的患者,经新辅助化疗后腋窝淋巴结转为阴性再接受前哨淋巴结活检,对照组(60例)为腋窝阴性的患者,直接接受前哨淋巴结活检,两组患者随后均接受腋窝淋巴结清扫(ALND),通过石蜡组织切片观察所有淋巴结的转移情况。结果观察组与对照组患者SLN假阴性率、灵敏度、准确率、检出率差异无统计学意义(P>0.05)。当观察组SLN检出个数≥3时,SLN假阴性率降低,差异有统计学意义(P=0.004)。结论乳腺癌患者NAC后行SLNB总体假阴性率较高,尚未达到临床可接受范围,不能完全取代ALND,对于初始ALN阳性经NAC后转阴的乳腺癌患者,SLN检出数目≥3时SLNB可准确评估ALN状态。

Objective To investigate the clinical value of sentinel lymph node biopsy(SLNB)ater neoadjuvant chemotherapy(NAC)for breast cancer.Methods One hundred and thirty patients with primary breast cancer(cT_(1-3)N_(0-2)M_(0))diagnosed by patholog from January 2417 to December 2419 were selected from the Department of Galactophore in According to the status of axillary lymph nodes,patients were divided into observation group group(74 cases)were patients with positive axillary lymph nodes.After neoadjuvant chemotherapy,the axillary lymph nodes turned negative and then received sentinel lymph node biopsy.The control group(64 cases)was patients should received sentinel lymph node biopsy directly.Both groups subsequently received aillary lymph All lymph node metastases were observed by paraffin section.Results There was no statistically significant difference in SLN false negative rate,sensitivity,accuracy and detection rate between the observation group and the control group(P>4.45).When the number of SLN detected in the observation group was≥3,the false negative rate of SLN was reduced,and the difference was statistically significant(P=4.044).Conclusion The overall false negative rate of SLNB after NAC in breast cancer patients is high,which has not reached the clinically acceptable range and cannot completely cancer patients whose initial ALN is positive and then turns negative by NAC,SLNB can accurately assess number of SLN detected is ≥3.