基于新型示踪技术检测乳腺癌内乳淋巴结转移并分析其危险因素

Detection of internal mammary lymph node metastasis in breast cancer based on new tracer technology and evaluation of risk factors

目的探讨基于新型示踪技术检测乳腺癌内乳淋巴结(internal mammary lymph node,IMLN)转移并分析其危险因素,为明确肿瘤TNM分期及制定精准治疗方案提供参考。方法回顾性收集2019年2月至2020年1月期间重庆医科大学附属第一医院收治且基于新型示踪技术行组织穿刺活检病理检查确诊为乳腺癌并行手术切除的女性患者,均行IMLN清扫,分析IMLN转移与乳腺癌患者的年龄、肿瘤大小(指长径)、肿瘤位置、肿瘤分级、雌激素和孕激素受体状态、人表皮生长因子受体-2状态、腋窝淋巴结(axillary lymph node,ALN)转移数目及病理分子分型的关系。结果本研究共纳入28例患者,采用新型示踪技术对ALN及IMLN的显影率分别为96.4%(27/28)和35.7%(10/28)。IMLN活检组织病理结果证实6例患者发生IMLN转移(此6例均为显影患者),IMLN转移率为21.4%。乳腺癌患者的IMLN转移与肿瘤位置及ALN转移数目有关(P<0.05),即肿瘤位于内侧象限及ALN转移数目≥4枚时IMLN转移率高于外侧象限(57.1%比10.0%,P=0.028)及ALN转移数目<4枚(50.0%比11.1%,P=0.038)的患者,未发现它与乳腺癌患者的年龄、肿瘤大小、肿瘤分级、雌激素和孕激素受体状态、人表皮生长因子受体-2状态及病理分子分型有关(P>0.05)。ALN转移数目评估IMLN转移的受试者操作特征曲线下面积为0.697。结论从本研究总结的病例结果看,新型示踪技术对IMLN显影率较高,当乳腺癌位于内侧象限及ALN转移数目≥4枚时,建议积极行IMLN活检以明确其病理诊断性质,以精准评估肿瘤分期及制定合适的个体化治疗方案。

Objective To investigate the risk factors of internal mammary lymph node(IMLN)metastasis in breast cancer patients,and to provide evidence for clarifying the TNM stage of tumors and formulating precise treatment plans.Methods The female patients who were admitted to the First Affiliated Hospital of Chongqing Medical University from February 2019 to January 2020 and diagnosed with breast cancer by tissue biopsy pathology based on the new tracer technology were retrospectively collected.All IMLNs were dissected.The associations of IMLN metastasis with patients'age,tumor size(long diameter),tumor location,tumor grade,estrogen and progesterone receptor statuses,human epidermal growth factor receptor-2(HER2)status,number of axillary lymph node(ALN)metastasis,and pathological molecular typing were analyzed.Results A total of 28 patients were included in this study.The visualization rates in the ALN and IMLN by the new tracer technique were 96.4%(27/28)and 35.7%(10/28),respectively.The pathological results of IMLN biopsy confirmed that 6 patients(The 6 cases were all displaying)had IMLN metastases,with an IMLN metastasis rate of 21.4%.The IMLN metastasis was related to the tumor location and ALN metastasis number of patients with breast cancer(P<0.05).That is to say,when the tumor located in the medial quadrant and the number of ALN metastasis was 4 or more,the IMLN metastasis rates were higher than those in the lateral quadrant(57.1%vs.10.0%,P=0.028)and in the patients with ALN metastasis number <4(50.0%vs.11.1%,P=0.038).It was not found that IMLN metastasis was related to age,tumor size,tumor grade,estrogen and progesterone receptor statuses,HER2 status,and pathological molecular typing of patients with breast cancer(P>0.05).And the area of the receiver operating characteristic curve of the number of ALN metastasis for assessing IMLN metastasis was 0.697.Conclusion From the summarized results of cases in this study,the visualization rate of IMLN is higher based on the new tracer technology.When breast cancer locates in the medial quadrant and the number of ALN metastasis is 4 or more,it is recommended to actively carry out IMLN biopsy to clarify the results of pathological diagnosis,so as to accurately assess the tumor stage and formulate appropriate individualized treatment plan.