新辅助化疗对可手术乳腺癌前哨淋巴结病理结果的影响

目的：研究新辅助化疗后乳腺癌前哨淋巴结活检结果是否真实可靠.方法：60例乳腺癌患者手术前应用2～3个疗程的新辅助化疗;48例化疗方案采用CEF（环磷酰氨60mg/m2,表柔比星70mg/m2,氟脲嘧啶60mg/m2）,12例患者采用CET（环磷酰氨50mg/m2,表柔比星50mg/m2,多西紫杉醇75mg/m2）.乳腺癌改良根治术前取亚甲蓝2ml皮下均衡注射于肿瘤四周各个象限,切除的标本计数淋巴结总数和染蓝的淋巴结数,与大体标本同时作常规病理检查.结果：66例乳腺癌患者中,60例前哨淋巴结染色成功（90.9%）,平均检查前哨淋巴结数为1～5枚/例.8例在手术前肿瘤已局部切除的患者前哨淋巴结均染色成功.60例患者前哨淋巴结癌转移阳性23例,其中同时腋窝淋巴结阳性15例,阴性8例.前哨淋巴结阴性的37例患者中,腋窝淋巴结阴性35例、阳性2例（前哨淋巴结假阴性占5.4%）,假阴性率为8%.48例采用CEF方案的患者,前哨淋巴结假阴性1例.12例采用CET方案的患者,前哨淋巴结假阴性1例.60例患者中58例前哨淋巴结准确地预测了腋窝淋巴结转移状况.结论：采用CET或CEF方案新辅助化疗的乳腺癌患者,其前哨淋巴结检查的病理结果同样能准确地反映腋窝淋巴结的转移状况.

Sentinel lymph node biopsy in patients with operable breast cancer after neoadjuvant systemic therapy

Objective: To investigate the feasibility and accuracy of sentinel lymph node biopsy(SLN) following neoadjuvant chemotherapy.Methods:Sentinel lymph node biopsy was evaluated following two or three cycles of neoadjuvant chemotherapy with pharmorubicin /cyclophosphamide/5-FU(CEF,48 patients) or pharmorubicin /cyclophosphamide / taxotere(CET,12 patients).Two ml 1% methylene blue was subcutaneously injected at 4 sites of the skin over the tumor before radical operation.Pathohistological results were assessed for all the specimen including blue lymph node and other axillary lymph node(ALND). Results:Among the 66 patients SLN was identified in 60 of them(90%).Residual metastatic disease was identified in 23 cases on SLN,including 15 positive and 8 negative node on ALND,37 cases were completely negative on SLN including 35 negative and 2 positive node on ALND,and SLN was falsely negative in 2 cases(8%).Conclusion:The success rate of sentinel node identification and the predict ability of the SLN for the pathologic status of the adjacent non-SLNs do not seem to be altered after neoadjuvant therapy.