新辅助化疗后腋窝淋巴结转阴乳腺癌患者前哨淋巴结活检研究  

Sentinel lymph node biopsy in clinically node-negative breast cancer patients after neoadjuvant chemotherapy

作　　者：刘广[1] 邱鹏飞[1] 王永胜[1] 周正波[1] 李永清[1] 刘雁冰[1] 赵桐[1] 陈鹏[1] 孙晓[1] 王春建[1] 张朝蓬[1] 

机构地区：[1]山东省肿瘤医院乳腺病中心,济南250117

出　　处：《中华内分泌外科杂志》2013年第2期111-114,共4页Chinese Journal of Endocrine Surgery

基　　金：山东省科学技术发展计划项目（2009GG10002019）;山东省医药卫生科技发展计划项目重点项目（2011HD012）

摘　　要：目的探讨新辅助化疗后腋窝降期为临床阴性乳腺癌患者前哨淋巴结活检（sentinellymphnodebiopsy，SLNB）的可行性和准确性。方法对新辅助化疗前均经细针穿刺细胞学证实腋窝淋巴结阳性，新辅助化疗后腋窝淋巴结转阴的147例乳腺癌，先行SLNB再行腋窝淋巴结清扫术（axillarylymphnodedis—section，ALND），并比较。结果147例SLNB与ALND的成功率、假阴性率、准确率分别为87．07％（128／147）、14．43％（14／97）、89．06％（114／128），其中14．84％（19／128）的患者SLN为腋窝惟一阳性淋巴结。腋淋巴结转阴率24．50％（36／147），完成新辅助化疗占化疗总周期数80％以上患者腋窝淋巴结转阴率40．54％（15／37），高于不足80％患者的19．09％（21／110），差异有统计学意义（P=0．009），且SLNB成功率和准确性均提高。新辅助化疗前初始腋窝cN1期患者与eN2～3期患者比较，其SLNB的假阴性率（6．82％VS24．44％，P=0．016）和准确率（95．31％VS82．81％，P=0．023）差异有统计学意义，而新辅助化疗前初始乳腺原发肿瘤大小及新辅助化疗后乳腺原发肿瘤降期对SLNB成功率和准确性均无显著影响。联合法SLNB的成功率、假阴性率及准确性均优于单纯蓝染料法。结论新辅助化疗后腋窝淋巴结转阴患者SLNB技术上可行，准确性可接受；新辅助化疗后通过SLNB进行腋窝分期，可望使患者在新辅助化疗中获益最大化。Objective To evaluate the feasibility and accuracy of sentinel lymph node biopsy（SLNB） in previous axillary node positive breast cancer patients whose axillary nodes turned negative after neoadjuvant chem- otherapy（NAC）. Methods 147 consecutive breast cancer patients with clinically node-negative after NAC were retrospectively analyzed. These patients underwent SLNB followed by complete axillary lymph node dissection. All patients were proved to be axillary node-positive by fine needle aspiration cytology before NAC. Results The i- dentification rate, false negative rate and accuracy for SLNB was 87.07% （ 128/147 ） , 14.43% （ 14/97 ） and 89.06% （114/128）respectively. SLNs were the only positive nodes in 14. 84% patients（ 19/128 ）. The rate of pathologically negative axillary lymph node was 24. 50% （36/147）, significantly higher in patients who received NAC more than 80% of the total cycles than in those who received NAC less than 80% of the total cycles （40. 54% vs 19. 09% , P = 0. 009 ）, and was accompanied with improved identification rate and accuracy of SL- NB. The difference of false negative rate（6. 82% vs 24.44%, P =0. 016）and accuracy（95.31% vs 82. 81%, P = 0, 023 ） had statistical significance between patients initially in axillary cN1 and in cN2 - 3, while no connec- tion was found with the initial size and down-stage of the primary tumor. The identification rate, false negative rate and accuracy were improved in patients with combined Methylene blue and99m Tc-SC than in patients with Methylene blue alone. Conclusions It is technically feasible to perform SLNB in clinically negative-node barest cancer patients after NAC, and the SLNB accuracy remains reasonable. It is possible to maximize the benefits of NAC by using SLNB to stage the axillary lymph nodes in patients who are node-negative after NAC.

关 键 词：乳腺癌 前哨淋巴结活检 新辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]