乳腺癌前哨淋巴结活检在新辅助化疗后的应用价值

Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy

目的通过对比术前未接受化疗和术前接受新辅助化疗两组乳腺癌患者前哨淋巴结活检的结果,探讨对术前接受新辅助化疗后降期的患者以核素法行前哨淋巴结活检的临床价值。方法以本院2006年4月~2009年3月期间收治的99例乳腺癌患者作为研究对象。术前未行化疗组60例,临床分期为T1~2N0M0,直接行前哨淋巴结活检。术前新辅助化疗组39例,临床分期T2~3N0M0,患者术前先给予3~4个疗程的新辅助化疗,降期为T1~2N0M0后再行前哨淋巴结活检。所有患者术前均经乳晕下4点平均注射99m锝标记的非过滤硫胶体,术中用γ探针探测腋窝具有放射活性的前哨淋巴结并切除,然后常规清扫腋窝Ⅰ、Ⅱ组淋巴结。术后对前哨淋巴结活检和腋窝淋巴结清扫的病理结果进行比较分析。结果A组成功率、假阴性率、灵敏度、特异度、准确性、阳性预测值和阴性预测值分别为98.3%、3.3%、96.7%、100%、98.3%、100%和96.7%。B组分别为100%、10%、90%、100%、94.9%、100%和90.5%。两组比较假阴性率、准确性均无统计学差异。(P均】0.05)。结论对新辅助化疗后降期的局部进展期乳腺癌患者,以核素法行前哨淋巴结活检仍能够获得较高的成功率,同早期乳腺癌患者相比假阴性率没有统计学差异。

Objective To study isotopic sentinel lymph node biopsy in the two groups of breast cancer patients,which had neoadjuvant chemotherapy or not before the operation,determining the feasibility of the isotopic sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy.Methods From April 2006 to March 2009,99 breast cancer patients were included in our single institution trial.In group A,60 patients with T1～2N0M0 were directly treated with sentinel lymph node biopsy.In group B: 39 patients with T2～3N0M0 received 3～4 cycles neoadjuvant chemotherapy until they became T1～2N0M0.All of the patients received a subareolar injection of 99m Technetium labeled unfiltered sulfur colloid.The sentinel lymph node was detected by a gamma probe during the operations.Then the axillary lymph node dissections were performed with level Ⅰ and level Ⅱ.All of the sentinel lymph nodes and axillary lymph nodes were sent for pathologic examination.Results In group A,the successful identification rate,false negative rate,sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 98.3%,3.3%,96.7%,100%,98.3%,100% and 96.7%,respectively.In group B,it was 100%,10%,90%,100%,94.9%,100% and 90.5%,respectively.The false negative rate and accuracy have no significant differences between the two groups(P>0.05).Conclusion This trial confirmed the feasibility of isotopic sentinel lymph node biopsy after neoadjuvant chemotherapy in the local advanced breast cancer patients.The false negative rate and accuracy did not differ from those obtained in the case of early breast cancer.