机构地区:[1]山东省肿瘤防治研究院(山东省肿瘤医院)乳腺病中心,山东济南250117 [2]山东第一医科大学(山东省医学科学院),山东济南250062 [3]山东大学,山东济南250100
出 处:《中国癌症杂志》2023年第6期574-580,共7页China Oncology
基 金:山东省自然科学基金(ZR2021QH164);北京医学奖励基金(YXJL-2020-0941-0762,YXJL-2020-0941-0740);北京科创医学发展基金(KC2021-JX-0044-1)。
摘 要:背景与目的:随着腋窝影像和超声引导活检技术的敏感性不断提高,一部分临床腋窝淋巴结阴性患者提升为临床腋窝淋巴结阳性(clinical lymph node positive,c N1)并接受了腋窝淋巴结清扫(axillary lymph node dissection,ALND)。本研究旨在分析,临床查体腋窝淋巴结阴性但超声检查发现可疑淋巴结并通过细针抽吸细胞学检查或空芯针活检(fineneedleaspirationcytology/core-needlebiopsypathology,FNAC/CNBP)确诊转移的患者,是否适合进行腋窝前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)。方法:回顾性分析山东省肿瘤防治研究院乳腺病中心2015年10月—2022年12月经治的原发性乳腺癌患者的病历资料,筛选获取术前超声检查发现腋窝可疑的转移淋巴结并通过FNAC/CNBP确诊转移并接受ALND患者的临床资料。所有数据均采用SPSS 27.0统计软件进行分析,P<0.05为差异有统计学意义。结果:其中158例患者术前超声检查发现1~2枚可疑淋巴结经FNAC/CNBP确诊有转移,ALND后发现43.7%(69/158)的患者存在1枚淋巴结转移,15.2%(24/158)存在2枚淋巴结转移,41.1%(65/158)存在2枚以上淋巴结转移。其中,65例(41.1%,65/158)患者接受了SLNB并进行了ALND,SLNB的假阴性率为0%,1~2枚腋窝前哨淋巴结(sentinel lymph node,SLN)转移的患者中61.5%(40/65)未发现非前哨淋巴结(non-sentinel lymph node,non-SLN)转移,发现1、2、3和3枚以上non-SLN转移的比例分别为10.8%(7/65)、4.6%(3/65)、6.2%(4/65)和16.9%(11/65),差异有统计学意义(P=0.042)。结论:临床查体淋巴结阴性但超声检查发现可疑淋巴结并通过FNAC/CNBP确诊1~2枚转移的患者行SLNB是安全可行的,然而这部分患者腋窝淋巴结转移的肿瘤负荷较高,需要更完备的放疗方案和全身治疗计划加强局部控制。Background and purpose:With the increasing sensitivity of axillary imaging and ultrasound guided biopsy,some clinically axillary negative patients were upstaged to axillary positive(cN1)and received axillary lymph node dissection(ALND).This study aimed to assess the feasibility of sentinel lymph node(SLN)biopsy(SLNB)in patients with axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with a fine-needle aspiration cytology/core-needle biopsy pathology(FNAC/CNBP).Methods:This retrospective cohort study included patients with early breast cancer who had axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with a FNAC/CNBP from October 2015 to December 2022 in the Breast Cancer Centre of Shandong Cancer Hospital and Institute.All patients received ALND.The data were analyzed by using SPSS version 27.0 statistical software,and P<0.05 was considered statistically significant.Results:A total of 158 patients were identified to have axilla negative evaluation by physical examination but one to two suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with FNAC/CNBP,43.7%(69/158)of them had only one ALN metastasis after ALND,15.2%(24/158)had only two ALNs metastases after ALND,and 41.1%(65/158)had more than two ALNs metastases after ALND.Among these cases,65 patients received SLNB followed by ALND,and the false negative rate of SLNB was 0%.Positive non-SLN metastasis rate was 0 in the 61.5%(40/65)patients with 1-2 positive SLNs metastasis.One,two,three and more than three non-SLN metastasis rates were 10.8%(7/65),4.6%(3/65),6.2%(4/65)and 16.9%(11/65),respectively(P=0.042).Conclusion:SLNB was safe and feasible in patients with axilla negative evaluation by physical examination but one to two suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with a FNAC/CNBP.In these patients,the axillary lymph node tumor bu
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