内乳淋巴结活检在乳腺癌分期与辅助治疗中的价值  

Value of Internal Mammary Lymph Node in Staging and Adjuvant Therapy of Breast Cancer

作　　者：贺青卿[1] 侯蕾[1] 范子义[1] 庄大勇[1] 郑鲁明[1] 肖蕾[1] 于芳[1] 周鹏[1] 朱见[1] 赵国伟[1] 

机构地区：[1]济南军区总医院甲状腺乳腺外科,山东济南250031

出　　处：《中国普外基础与临床杂志》2014年第5期549-554,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：山东省自然科学基金资助项目(编号:ZR2012HM072);中国博士后科学基金资助项目(编号:20080431408;201003759);济南军区总医院院长基金资助项目(编号:2011M03;2013ZD005)~~

摘　　要：目的分析乳腺癌经肋间隙内乳淋巴结切除活检在乳腺癌分期与辅助治疗中的价值。方法回顾性分析济南军区总医院甲状腺乳腺外科2003年5月至2014年1月期间305例(根据是否行新辅助化疗分为新辅助化疗组和无新辅助化疗组)行乳腺癌各式改良根治术与经肋间隙内乳淋巴结切除活检患者的相关临床与病理资料,包括患者年龄、腋窝淋巴结、内乳淋巴结转移状况等信息,分析内乳淋巴结对乳腺癌分期与治疗的影响。结果新辅助化疗组共收集乳腺癌患者67例,发生腋窝淋巴结转移者45例(67.2%),内乳淋巴结转移者23例(34.3%);乳腺癌淋巴结病理(pN)分期改变者23例(34.3%),乳腺癌肿瘤病理(pTNM)分期改变者8例(11.9%)。无新辅助化疗组共收集乳腺癌患者238例,发生腋窝淋巴结转移者155例(65.1%),内乳淋巴结转移者30例(12.6%);乳腺癌pN分期改变者30例(12.6%),pTNM分期改变者23例(9.66%)。新辅助化疗组的内乳淋巴结转移率明显高于无新辅助化疗组(χ2=15.7,P<0.05),pTNM分期改变率也明显高于无新辅助化疗组(χ2=5.3,P<0.05)。结论经肋间隙内乳淋巴结活检对乳腺癌pN分期、pTNM分期有一定的影响。新辅助化疗不能使所有内乳淋巴结转移癌达到病理完全缓解。经肋间隙内乳淋巴结活检不仅可完善乳腺癌pN和pTNM分期,而且能够指导乳腺癌术后辅助治疗,减少内乳区局部过度治疗,有助于乳腺癌患者个体化治疗。Objective To analyze the value of internal mammary lymph node biopsy via intercostal space in staging and adjuvant therapy of breast cancer. Methods The clinical data of 305 breast cancer patients received any kind of radical mastectomy from May 2003 to January 2014 in the Jinan Military General Hospital of PLA were analyzed retrospectively. The patient age, axillary lymph node, and internal mammary lymph node status were integrated to investigate the changing of staging and postoperative adjuvant therapy of the breast cancer. Results These 305 patients were divided into neoadjuvant chemotherapy group and non-neoadjuvant therapy group. There were 67 patients in the neoadjuvant chemotherapy group, including 45 （67.2%） patients with axillary lymph node positive, 23 （34. 3%） patients with internal mammary lymph node positive. There were 23 （34. 3%） patients who had a change of pathology lympy node （pN） staging and 8 （11.9%） patients who had a change of the pTNM staging. Meanwhile, there were 238 patients in the non-neoadjuvant chemotherapy group, including 155 （65.1%） patients with axillary lymph node positive, 30 （12. 6%） patients with internal mammary node positive. There were 30 （12.6%） patients who had a change of the pN staging and 23 （9. 66%） patients who had a change of the pTNM staging. There was a significant difference in the metastasis rate ofthe internal mammary lymph node （χ2=15.7, P〈0. 05） or the changing ratio of the pTNM staging （χ2=5.3, P〈0. 05） in two groups. Conclusions Internal mammary lymph node status could affect pN staging of breast cancer, so do the pTNM staging （TNM, pathology tumor, lymph node, metastasis）. The internal mammary lymph node status could guide the postoperative adjuvant radiative therapy by reducing excessive treatment of the internal mammary lymph node area, also could enhance the individual accurate therapy.

关 键 词：乳腺癌 内乳淋巴结 活检 转移 分期 放射治疗 

分 类 号：R737.9[医药卫生—肿瘤]