乳腺癌新辅助化疗后前哨淋巴结活检临床应用价值的探讨  

Clinical value of sentinel lymph node biopsy for the breast cancer patients receiving neoadjuvant chemotherapy

作　　者：潘蕊[1] 杨奔[1] 左文述[1] 杨莉[1] 王永胜[1] 郑刚[1] 郑美珠[1] 于志勇[1] 刘岩松[1] 

机构地区：[1]山东省医学科学院山东省肿瘤医院外科,山东济南250117

出　　处：《中华肿瘤防治杂志》2012年第24期1883-1888,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：中国前哨淋巴结活检多中心协作研究(CBCSG-001)

摘　　要：目的:研究分析乳腺癌患者新辅助化疗(NAC)后前哨淋巴结活检(SLNB)检出率和假阴性率的影响因素,探讨乳腺癌NAC后SLNB的可行性。方法:2004-01-01-2012-06-30初诊于山东省肿瘤医院可手术乳腺癌患者241例,所有患者均接受NAC。分析NAC后SLNB的检出率和假阴性率,并探讨患者临床病理因素与SLNB检出率、假阴性率和准确率的相关性。结果:入组患者SLNB检出率为86.3%(208/241),假阴性率为15.0%(22/147),准确率为89.4%(186/208)。单因素分析发现,SLNB检出率与示踪方法呈现明显相关,联合示踪法明显增加前哨淋巴结(SLN)的检出率,P=0.038;NAC前腋淋巴结(ALN)肿大有增加患者假阴性率的趋势,P=0.060,但是其他病理因素与SLNB假阴性率均无明显相关;SLN准确率与NAC前ALN状态明显相关,P=0.032。结论:SLNB可以应用于乳腺癌NAC后的患者;联合示踪法明显提高SLN的检出率;NAC前ALN转移状况影响SLNB的假阴性率和准确率,NAC后SLNB替代腋淋巴结清除术(ALND)可能有一定的风险。OBJECTIVE： To research the feasibility of sentinel lymph node biopsy（SLNB） after neoadjuvant chemo- therapy（NAt） in breast cancer patients. METHODS： All 241 patients with local advanced breast cancer from 2004-01-01 to 2012-06-30 in Shandong cancer hospital receiving standard NAG before surgery. All of them underwent SLNB before breast surgery,and then completed axillary lymph node dissection （ALND） followed immediately. SLN identification and false-negative rates of the cases were analyzed. Factors associated with SLN identification and false-negative rates were al- so analyzed retrospectively. RESULTS：The identification rate for SLNB was 86.3 % （208/241） ; the false negative rate was 15.0%（22/147）; and the accuracy rate was 89.4%（186/208）. Method of lymphatic was mapping significantly related with the identification rate of SLNB（P= 0. 038）, Clinical nodal status before chemotherapy had a trend to increase the false-negative rates of the SLNB for the patients after NAC （P=0. 060）,and significantly influenced the accuracy rate of the SLNB（P= 0. 032）. CONCLUSIONS：SLNB is feasible and applicable in breast cancer patients who have received neoad- juvant chemotherapy. The Method of lymphatic mapping significantly influenced the identification rate of SLNB, and the clinical nodal status before chemotherapy is related with the false-negative rate and accuracy rate of SLNB. There are some risks for SLNB instead of ALND after NCA.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 化学疗法 辅助 假阴性反应 

分 类 号：R737.9[医药卫生—肿瘤]