乳腺癌新辅助化疗后原发灶临床完全缓解对腋淋巴结转阴的预测作用

目的判断腋窝淋巴结阳性乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)后原发灶临床完全缓解能否预测腋窝淋巴结病理转阴。方法 2016年10月~2019年10月收治的乳腺癌病人95例,淋巴结穿刺均阳性,临床分期T1-3,N1-2期,且均完成NAC后有腋窝淋巴结清扫(axillary lymph node dissection,ALND),评估NAC后磁共振(magnetic resonance imaging,MRI)判断的原发灶临床完全缓解预测腋窝淋巴结病理转阴的效果。结果 95例病人NAC后原发灶临床完全缓解39例,完全缓解率41.1%(39/95),术后腋窝淋巴结病理完全缓解45例,完全缓解率47.4%(45/95)。原发灶MRI结果预测ALND结果的敏感性、特异性、阴性预测值及假阴性率分别为82.0%(95%CI:68.1%~91.0%),66.7%(95%CI:50.9%~79.6%),76.9%(95%CI:60.3%~88.3%),18.0%(95%CI:9.0%~31.9%)。分层分析显示,Her-2过表达型及三阴性病人原发灶MRI阴性预测值及假阴性率分别为95.8%(95%CI:76.9%~99.8%),7.1%(95%CI:0~14.9%)。结论淋巴结阳性乳腺癌NAC后原发灶临床完全缓解总体不能准确预测腋窝淋巴结病理转阴,但Her-2过表达型及三阴性乳腺癌具有很高的转阴预测价值。

The value of clinical complete response of primary tumor in predicting pathological complete response of axillary lymph nodes in node-positive breast cancer patients following neoadjuvant chemotherapy

Objective To determine whether the complete clinical response(cCR) of primary tumor evaluated by Magnetic resonance imaging(MRI)can predict a pathological complete response(pCR)results of axillary lymph nodes in biopsy-proven node-positive breast cancer following neoadjuvant chemotherapy(NAC).Methods Patients with pathologically confirmed T1-3,N1-2 breast cancer underwent axillary lymph node dissection(ALND) after NAC were collected between October 2016 and October 2019.The response of NAC assessed by MRI of breast primary tumor in predicting axillary lymph node status was analyzed.Results 95 consecutive node-positive breast cancer patients were collected.After NAC,the cCR rate of primary tumor was 41.1%(39/95) and the pCR rate of axillary lymph nodes was 47.4%(45/95).The sensitivity,specificity,negative predictive value and false negative rate of MRI were 82.0%(95%CI:68.1%-91.0%),66.7%(95%CI:50.9%-79.6%),76.9%(95%CI:60.3%-88.3%) and 18.0%(95%CI:9.0%-31.9%),respectively.However,the stratified analysis showed that the negative predictive value of the primary tumor MRI were 95.8%(95%CI:76.9%-99.8%) in Her-2 overexpression and triple negative patients,What’s more,the false negative rate was 7.1%(95%CI:0-14.9%).Conclusion The complete clinical response of breast primary tumor evaluated by MRI after NAC for node-positive breast cancer can not accurately predict a Negative pathological status of ALN.However,the stratified analysis shows that Her-2 overexpression and triple negative patients who achieve cCR can obtain a high negative predictive value and a low false negative rate.