乳腺癌新辅助化疗后前哨淋巴结活检的临床应用价值  

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

作　　者：郑爱秋[1] 刘瑞霞 朱运添[1] 周颉[1] 刘敏[1] 石剑[1] 傅建民[1] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院乳腺甲状腺科,深圳518028 [2]深圳市人民医院龙华分院

出　　处：《中华妇幼临床医学杂志（电子版）》2012年第6期614-617,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：深圳市科技计划项目资助(201003119)~~

摘　　要：目的探讨新辅助化疗后乳腺癌前哨淋巴结活检(SLNB)的临床应用价值。方法收集2010年6月至2012年6月于本院行改良根治术或保乳术的乳腺癌患者42例(ⅡB期为28例,ⅢA期为10例,ⅢB期为4例)为研究对象,对其行亚甲蓝示踪SLNB和腋窝淋巴结清扫术(ALND)后进行分析。患者先行4～6个疗程新辅助化疗(CEF方案或TEC方案)后再行SLNB及ALND,所有前哨淋巴结(SLN)和腋窝淋巴结均行病理学和免疫组化检查(本研究遵循的程序符合南方医科大学附属深圳市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准)。结果 SLN检出率、假阴性率、灵敏度、准确性、阴性预测值分别为88.1%,13.3%,80.0%,94.6%,92.6%。新辅助化疗前原发肿瘤直径(≤5cm与>5cm),BMI(<25kg/m2与≥25kg/m2)和临床N分期(N1及以下与N2及以上)与化疗后SLN检出率间比较,差异有统计学意义(P<0.05)。结论新辅助化疗后SLNB能准确预测腋窝淋巴结状况,化疗前肿瘤直径、临床N分期和BMI是SLN检出率的影响因素。Objective To investigate the feasibility, accuracy and clinical significance of sentinel lymph node biopsy （SLNB） for breast cancer patients after neoadjuvant chemotherapy. Methods From June 2010 to June 2012, forty-two breast cancer patients （staging ⅡB were 28 cases, staging ⅢA were 10 cases, staging ⅢB were 4 cases） underwent SLNB by using methylene blue dye as tracer and axillary lymph node dissection （ALND） were retrospectively reviewed. Patients of staging ⅡB and Ⅲ underwent SLNB and ALND after 4-6 circles neoadjuvant chemotherapy. The SLN and ALN specimens were carried out histopathological examination with HE and immunohistochemstry. Results The SLN successful identification rate, false negative rate, sensitivity, accuracy, and negative predictive value was 88.1%, 13.3%, 80.0%, 94.6%, 92.6%, respectively, in breast cancer patients with neoadjuvant chemotherapy. In addition, there had significant differences between SLN identification rate after neoadjuvant chemotherapy and tumour diameter （≤5 cm and 5 cm）, BMI （25 kg/m2 and ≥25 kg/m2）, and clinical N stage （N2 stage and N0-1 stage） before neoadjuvant chemotherapy （P0.05）. Conclusions The SLNB can accurately predict lymph node status of axillary lymph node in patients with neoadjuvant chemotherapy. Clinical N stage, BMI and tumour diameter are predictors to the identification rate of SLND in the breast cancer patents.

关 键 词：乳腺癌 新辅助化疗 前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]