乳腺癌围新辅助化疗期前哨淋巴结活检的可行性分析  

Feasibility of sentinel lymph node biopsy peri-neoadjuvant chemotherapy in breast cancer

作　　者：赵晶[1] 宋志武[2] 黄焰[2] 郝晓鹏[2] 梁峰[2] 王世彬[2] 进淑娟[2] 尉承泽[2] 

机构地区：[1]解放军军医进修学院,北京100853 [2]军事医学科学院附属解放军第三○七医院普外科,北京100853

出　　处：《中华医学杂志》2012年第36期2538-2541,共4页National Medical Journal of China

基　　金：北京市科技计划项目（D09050703570905）

摘　　要：目的探讨乳腺癌患者围新辅助化疗期前哨淋巴结活检可行性。方法对2005年1月至2011年11月252例乳腺癌患者行前哨淋巴结活检和腋窝淋巴结清扫术。其中新辅助化疗前组150例，新辅助化疗后组102例。比较不同腋窝淋巴结临床状态下前哨淋巴结活检的可行性。结果新辅助化疗前行前哨淋巴结活检，无论腋窝淋巴结临床阴性或阳性，其哨兵淋巴结检出率（98．5％比92．8％）、假阴性率（6．7％比7．9％）、准确度（98．4比％91．9％）、阴性敏感度（97．9％比88．O％）无统计学差异，但阳性组前哨淋巴结转移率显著高于阴性组（28．8％比67．5％，P=0．000）。与新辅助化疗前行前哨淋巴结活检相比，新辅助化疗后行前哨淋巴结活检，其前哨淋巴结假阴性率明显升高（7．5％比23．9％，P=0．024）；准确度和阴性敏感度显著降低（95．1％比83．5％，P=0．005；94．4％比75．O％，P=0．003）；初诊腋窝淋巴结阴性患者新辅助化疗后行前哨淋巴结活检，其前哨淋巴结检出率、假阴性率、准确度、阴性敏感度与新辅助化疗前行前哨淋巴结活检差异无统计学意义。初诊腋窝淋巴结病理证实转移阳性新辅助化疗后行前哨淋巴结活检较新辅助化疗前行前哨淋巴结活检，其前哨淋巴结准确度（98．4％比83．7％，P=0．010）；SLN转移率（28．8％比53．7％，P=0．005）；阴性敏感度（97．9％比68．O％，P：0．007）；初诊腋窝淋巴结病理证实转移阳性新辅助化疗后腋窝淋巴结转阴者。较新辅助化疗前前哨淋巴结活检，其SLN转移率（28．8％比65．0％，P：0．003），阴性敏感度显著降低（94．4％比57．1％，P=0．005）。结论新辅助化疗前前哨淋巴结可准确预测腋窝淋巴结转移状态；初诊腋窝淋巴结阴性，新辅助化疗后前后哨淋巴结活检相同；初诊腋窝淋巴结转移阳性，无论新辅助�Objective To explore the feasibility of sentinel lymph node biopsy in peri-neoadjuvant chemotherapy for breast cancer patients. Methods A total of 252 breast cancer patients underwent sentinel lymph node biopsy and axillary lymph node dissection from January 2005 to November 2011, including 150 patients in pre-neoadjuvant chemotherapy group and 102 in post-neoadjuvant chemotherapy group. The feasibility of sentinel lymph node biopsy under different clinical states of axillary lymph node was compared. Results No significant difference was found in the detection rate （98.5% vs 92. 8% ）, false negative rate （6. 7% vs 7.9% ）, accuracy （98.4% vs 91.9% ） and negative sensitivity （97. 9% vs 88.0% ） of sentinel lymph node biopsy before neoadjuvant chemotherapy whether the axillary lymph node was negative or positive. However, the transfer rate of sentinel lymph node in the positive group was significantly higher than the negative group （28. 8% vs 67.5% , P = 0. 000）. False negative rate of sentinel lymph node in biopsy was significantly higher in the post-neoadjuvant chemotherapy group than the pre-neoadjuvant chemotherapy group （7. 5% vs 23.9%, P = O. 024） and the accuracy/negative sensitivity decreased significantly （95.1%vs 83.5% , P = 0. 005/94. 4% vs 75.0% , P = 0. 003 ）. No statistical difference existed in the detection rate, false negative rate, accuracy, negative sensitivity of sentinel lymph node in biopsy before and after neoadjuvant chemotherapy in patients with negative axillary lymph node for a preliminary diagnosis. The accuracy of sentinel lymph node decreased significantly in biopsy after neoadjuvant chemotherapy in patients with positive axillary lymph node confirmed pathologically for a preliminary diagnosis compared with before （98.4/83.7% , P = 0. 010 ） , the transfer rate of sentinel lymph node increased significantly（ 28.8/53.7% , P = 0. 005 ） and negative sensitivity reduced significantly （ 97. 9/68.0% , P = 0. 007 ） ; Compared with pre- neoadjuvant chemothe

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 新辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]