新辅助化疗后腋窝淋巴结临床转阴乳癌病人前哨淋巴结活检的可行性  

FEASIBILITY OF SENTINEL LYMPH NODE BIOPSY IN BREAST CANCER PATIENTS WITH NEGATIVE AXILLARY LYMPH NODE METASTASIS AFTER NEOADJUVANT CHEMOTHERAPY

作　　者：刘波 王海波[3] 潘宝军 毛艳[3] LIU Bo;WANG Haibo;PAN Baojun;MAO Yan(Qing-dao University Medical College,Qingdao 266003,China)

机构地区：[1]青岛大学医学部,山东青岛266003 [2]枣庄市立医院新城分院普外科 [3]青岛大学附属医院乳腺病诊疗中心 [4]昌乐县人民医院乳腺甲状腺外科

出　　处：《青岛大学学报（医学版）》2021年第3期356-360,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金资助项目(81772845);山东省自然科学基金资助项目(ZR2017MH016)。

摘　　要：目的探讨乳癌新辅助化疗后腋窝淋巴结阳性降期为临床阴性的病人前哨淋巴结活检的可行性。方法收集2018年1月—2019年12月于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗且腋窝淋巴结降期为临床阴性,并于该中心接受前哨淋巴结活检和腋窝淋巴结清扫的病人86例,对比前哨淋巴结活检与腋窝淋巴结清扫的病理结果,分析前哨淋巴结活检的检出率、假阴性率、准确率和灵敏度,并对可能的影响因素进行分层分析。结果 86例病人的整体检出率、假阴性率、准确率和灵敏度分别为100.0%(86/86)、16.4%(9/55)、89.5%(77/86)和83.6%(46/55)。与临床N_2分期、体质量指数(BMI)≥25 kg/m^(2)、乳癌病理检查未完全缓解、前哨淋巴结取出<3枚的病人相比,临床N_1分期、BMI<25 kg/m^(2)、乳癌病理检查完全缓解、前哨淋巴结取出≥3枚病人的假阴性率明显降低,而准确率明显升高,差异均有统计学意义(χ^(2)=4.120~81.371,P<0.05)。结论乳癌新辅助化疗后腋窝淋巴结阳性降期为临床阴性病人行前哨淋巴结活检的整体假阴性率较高,而对于临床N_1分期、BMI<25 kg/m^(2)、前哨淋巴结取出≥3枚者前哨淋巴结活检术可较精准评估腋窝淋巴结状态。Objective To investigate the feasibility of sentinel lymph node biopsy in breast cancer patients with positive axillary lymph node metastasis downstaged to negative after neoadjuvant chemotherapy.Methods A total of 86 breast cancer patients who had positive axillary lymph node metastasis downstaged to negative after neoadjuvant chemotherapy and underwent sentinel lymph node biopsy and axillary lymph node dissection in Breast Disease Center,The Affiliated Hospital of Qingdao University,from January 2018 to December 2019 were enrolled.The pathological results of sentinel lymph node biopsy and axillary lymph node dissection were compared,and sentinel lymph node biopsy was analyzed in terms of detection rate,false negative rate,accuracy rate,and sensitivity.A stratified analysis was performed for possible influencing factors.Results For all 86 patients,the overall detection rate,false negative rate,accuracy rate,and sensitivity were 100.0%(86/86),16.4%(9/55),89.5%(77/86),and 83.6%(46/55),respectively.Compared with the patients with clinical N 2 stage disease,body mass index(BMI)≥25 kg/m^(2),incomplete pathological remission of breast tumor,or<3 sentinel lymph nodes removed,the patients with clinical N 1 stage disease,BMI<25 kg/m^(2),complete pathological remission of breast tumor,or≥3 sentinel lymph nodes removed had a significantly lower false negative rate and a significantly higher accuracy rate(χ^(2)=4.120-81.371,P<0.05).Conclusion Sentinel lymph node biopsy has a high overall false negative rate in breast cancer patients with positive axillary lymph node metastasis downstaged to negative after neoadjuvant chemotherapy,while it can accurately assess the status of axillary lymph node in patients with clinical N 1 stage disease,BMI<25 kg/m^(2),or≥3 sentinel lymph nodes removed.

关 键 词：乳房肿瘤 化学疗法 辅助 前哨淋巴结活组织检查 可行性研究 

分 类 号：R655.8[医药卫生—外科学] R737.9[医药卫生—临床医学]