乳腺癌局部进展期新辅助化疗后哨兵淋巴结活检准确性的临床观察

目的 探讨局部进展期乳腺癌新辅助化疗对哨兵淋巴结活检（SLNB）准确性的影响。方法选择近2年该科临床Ⅱ、Ⅲ期原发性乳腺癌80例，应用亚甲蓝单一染料示踪剂瘤周或乳晕周边皮下注射，先行SLNB再行腋窝淋巴结清扫术（ALND）；哨兵淋巴结（SLNs）和腋窝淋巴结（ALNs）石蜡包埋切片，常规H—E染色。其中39例行新辅助化疗，41例未行新辅助化疗，两组病人比较SLN检出率，假阴性率（FNR），准确性，敏感度（NPV），评价新辅助化疗与非化疗对SLNB的影响程度。结果两组病人总的SLN检出率为93．75％（75／80）；新辅助化疗组检出率为94．87％（37／39），未化疗组为92．68％（38／41）；新辅助化疗组与非化疗组两组相比较FNR 31．58％（6／19），33．34％（5／15）；NPV 66．67％（12／18），78．26％（18／23）；准确性83．78％（31／37），86．84％（33／38），结果无统计学差异（P＞0．05）。结论乳腺癌局部进展期新辅助化疗后SLNB仍可准确预测腋窝淋巴结转移状态，新辅助化疗后的部分病人SLNB有可能取代ALND，另外新辅助化疗明显增加了保乳手术率。

Sentinel lymph node biopsy following neoadjuant chemotherapy for locally advanced breast cancer

[Objective] To evaluate the accuracy of axillary staging following neoadjuvant chemotherapy for locally advanced breast cancer by comparing the patients without chemotherapy.[Methods] We prospectively studied the feasibility of sentinel lymph nod biopsy(SLNB) following neoadjuvant chemotherapy for locally advanced breast cancer by comparing the identification rate,the false-negative rate(FNR),negative predicative value(NPV),and accuracy with the results obtained from the patients without chemotherapy.A total of 80 patients underwent SLNB and axillary lymph node dissection(ALND) at our department.Of the 80 patients,39 underwent neoadjuvant chemotherapy prior to operation.The sentinel lymph node(SLN) was mapped by blue dye alone.All SLNs were evaluated by sections after hematoxylin-eosin staining.[Results] The overall SLNs identification rates were 93.75%(75/80),94.87%(37/39) of patients after chemotherapy and 92.68%(38/41) of patients without chemotherapy.Among the patients with chemotherapy,there were an FNR of 31.58%(6/19),an accuracy of 83.78%(31/37),and a NPV of 68.42(13/19).For patients without chemotherapy,there were an FNR of 33.34%(5/15),an accuracy of 86.84%(33/38),a NPV of 66.67%(10/15),an accuracy of 86.84%(33/38).There results were not statistically different when compared(P>0.05).[Conclusion] SLNB is accurately predicted the axillary status and could be an alternation to ALND after neoadjuvant chemotherapy.Neoadjuvant chemotherapy increased use of breast-conserving therapy following advanced breast cancer.