新辅助化疗对乳腺癌腋淋巴结及结外侵犯的影响

目的 旨在观察局部进展期乳腺癌新辅助化疗时腋淋巴结及结外侵犯的临床病理学改变.方法 2002年6月-2009年8月南京大学附属第二医院收治的肿块大于5 cm伴同侧腋淋巴结肿大但不融合的86例患者,以患者是否愿意行新辅助化疗分组,A组患者46例,不愿行新辅助化疗,穿刺确诊后行手术治疗,术后病理证实,腋淋巴结转移40例,转移腋淋巴结结外侵犯17例.B组患者40例,自愿行新辅助化疗,穿刺确诊后平均行3个周期新辅助化疗,再行手术治疗,术后病理证实,腋淋巴结转移26例,转移腋淋巴结结外侵犯6例.结果 A组患者淋巴结转移率为86.9%,转移淋巴结并结外侵犯率为36.9%;B组患者淋巴结转移率为65%,转移淋巴结结外侵犯率为15%,两组病例在淋巴结转移率及转移淋巴结结外侵犯率之间存在显著差异,P<0.05.结论 新辅助化疗对于患者的腋淋巴结转移灶有明显作用,减少了淋巴结转移率及转移淋巴结结外侵犯率.     

乳腺癌新辅助化疗后腋窝淋巴结的变化

目的评价新辅助化疗对乳腺癌腋窝淋巴结的影响。方法45例Ⅱ、Ⅲ期乳腺癌接受新辅助化疗后手术(新辅助化疗联合手术组),根据体检、B超及钼靶像计数腋窝淋巴结总数和阳性、阴性淋巴结数,与未行新辅助化疗直接手术治疗的79例乳腺癌(直接手术组)比较,观察腋窝淋巴结的变化。结果新辅助化疗联合手术组检出腋窝总淋巴结和阳性淋巴结为(16.9±5.9)枚和(2.5±2.2)枚,显著低于直接手术组的(20.8±8.0)枚和(3.9±3.0)枚(t=-2.856,P=0.005;t=2.790,P=0.006),2组阴性淋巴结分别为(14.4±5.4)枚和(16.7±7.0)枚,无统计学差异(t=-1.904,P=0.055)。新辅助化疗联合手术组40例随访6~19个月,平均10个月;直接手术组67例随访7~21个月,平均12个月,2组各有4例复发。结论乳腺癌经新辅助化疗后行腋窝淋巴结清扫所检出的淋巴结总数和阳性淋巴结数减少。     

乳腺癌新辅助化疗后前哨淋巴结活检术的研究

目的 探讨乳腺癌病人新辅助化疗后前哨淋巴结活检的可行性。方法对2003年11月至2004年10月住院治疗中的57例Ⅱ、Ⅲ期乳腺癌病人行新辅助化疗后，临床检查腋窝淋巴结阴性行前哨淋巴结活检术（SLNB）。结果57例中检出前哨淋巴结（SLN）53例，检出率93．0％。SLN对腋窝淋巴结状况预测的敏感性为89．7％，特异性为100．0％，准确性为94．3％，阳性预测值为100．0％，阴性预测值为88．9％，假阴性率为5．7％。肿瘤对化疗反应为CR（完全缓解）、PR（部分缓解）和SD（稳定）的SLN检出率分别为100．0％、96．7％和70．0％（P〈0．01）。SLN假阴性3例均为腋窝淋巴结转移数〉4个者。结论Ⅱ、Ⅲ期乳腺癌实施新辅助化疗后。行SLNB可获得与早期乳腺癌SLNB相似的效果。     

乳腺癌新辅助化疗后前哨淋巴结活检的研究进展

在早期可手术乳腺癌病人中,前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)早已替代了传统的腋窝淋巴结清扫术(axillary lymph node dissection,ALND),使腋窝淋巴结(axilla-ry lymph node,ALN)阴性的病人减少了因腋清所导致的术后上肢肿...     

乳腺癌新辅助化疗后行前哨淋巴结活检47例分析

新辅助化疗后前哨淋巴结活检(SLNB)是否仍有价值是当前乳腺外科领域存在争议的问题。本文总结分析我院原发性乳腺癌行新辅助化疗后SLNB情况,旨在探讨其应用价值及可行性。     

增强磁共振成像对乳腺癌新辅助化疗后病理完全缓解的预测价值

目的 探讨增强磁共振成像(magnetic resonance imaging,MRI)预测乳腺癌患者新辅助治疗(neoadjuvant chemotherapy,NAC)后病理完全缓解(pathologic complete response,pCR)的准确性。方法 回顾性收集2020年3月至2022年4月期间于西南医科大学附属医院就诊并完成了NAC后行手术治疗的245例浸润性乳腺癌患者临床病理资料。根据免疫组织化学检测的激素受体(hormone receptor,HR)和人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)结果分为HR⁺/HER2^–、HR⁺/HER2⁺、HR^–/HER2⁺及HR^–/HER2^–4个亚组。以术后病理学结果为金标准,与术前MRI评估的残余肿瘤大小作对比,分析MRI评价NAC疗效的价值。同时分析增强MRI评估结果预测pCR的...     

淋巴结阴性乳腺癌的辅助化疗

淋巴结阴性乳腺癌是否需要辅助化疗或什么样病人应给予化疗 ,这是乳腺癌综合治疗的热点问题 ,现就有关的几个方面谈一些个人的体会。一、淋巴结阴性乳腺癌的自然病程及影响其预后的因素综合文献资料 ,在淋巴结阴性的乳腺癌病人中有约 70 %单纯通过局部治疗 (手术或加放疗 )而治     

新辅助化疗对晚期乳腺癌的作用

晚期乳腺癌的治疗在临床上是较为棘手的，尤其是肿瘤巨大、广泛侵犯皮肤和胸壁的情况出现时，难以施行外科手术。近十年来新辅助化疗在临床上的应用越来越广泛，其对晚期乳癌的治疗作用也得到肯定。但对采用何种化疗方案和剂量目前尚无统一的意见。我们近三年来对晚期乳腺癌患者开展了新辅助化疗，现报告如下。     

磁共振功能参数对乳腺癌新辅助化疗疗效早期预测价值研究

目的 探索磁共振（MRI）功能成像对乳腺癌新辅助化疗（NAC）疗效的早期预测价值。方法 回顾性分析2010年1月至2014年12月北京大学第一医院乳腺疾病中心接受NAC的151例乳腺癌病人资料。根据NAC前后组织病理学疗效评价分为病理显效组（GR）与病理非显效组（MR）;分析两组病人在NAC 2周期后MRI肿瘤径线变化率（ΔD%）和功能成像参数表观扩散系数ADC值、最大线性斜率（Smax）的变化率（ΔADC%、ΔSmax%）以及时间-信号强度曲线（TIC）类型变化（ΔTIC）与组织病理学疗效评价的关系;绘制ΔD%、ΔADC%、ΔSmax%以及ΔTIC在2周期的变化与组织病理学疗效的曲线,计算ROC曲线下面积（AUC）。应用ΔADC%、ΔSmax%建立NAC 2周期后疗效预测模型logit P。结果 NAC 2周期前后2组ΔADC%、ΔSmax%以及ΔTIC差异有统计学意义（P<0.001）。ΔD%、ΔADC%、ΔSmax%以及ΔTIC的AUC分别为0.600、0.820、0.807和0.786。logit P与组织病理学疗效的AUC为 0.898（95%CI 0.844～0.953）。结论 以2周期MRI功能参数变化为基础的早期疗效预测模型对NAC疗效具有预测价值。     

乳腺癌新辅助化疗后蓝染法行前哨淋巴结活检术的临床分析

【摘要】 目的 研究乳腺癌患者新辅助化疗后蓝染法行前哨淋巴结活检术(SLNB)的可行性。方法〓回顾性分析2012年1月至2015年6月初诊于广西柳州市工人医院普外四病区的IIA-IIIB期乳腺癌患者69例。所有患者均接受新辅助化疗,疗程4~8个周期,分析新辅助化疗后蓝染法行SLNB的检出率、假阴性率。结果〓入组患者SLNB检出率为85.5%,假阴性率为18.2%;SLNB的检出率因腋窝淋巴结状态不同而存在统计学差异,在不同肿瘤的大小、肿瘤位置、患者年龄和SLNB时注射染料位置无统计学差异,假阴性率在上述不同分组中均无统计学差异。结论〓NAC后蓝染法SLNB可应用于治疗前腋窝淋巴结阴性的乳腺癌患者;对于治疗前腋窝淋巴结阳性的患者则存在风险。增加SLN检出数目可增加NAC后行SLNB的可靠性。     

Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer

The purpose of this study was to evaluate the feasibility of sentinel lymph node mapping in patients undergoing neoadjuvant chemotherapy for breast carcinoma prior to lumpectomy or mastectomy and sentinel lymph node mapping followed by complete axillary dissection. A retrospective analysis of 14 patients from February 1998 to July 2000 with stage I to stage IIIB breast cancer diagnosed by core biopsy underwent neoadjuvant chemotherapy (doxorubicin/cyclophosphamide) prior to definitive surgery, including lumpectomy or mastectomy and sentinel lymph node mapping, followed by full axillary dissection. Thirteen of 14 patients had successful sentinel lymph node identification (93%), and all 14 underwent full axillary dissection. An average of 2.2 sentinel nodes and a median of 16 axillary lymph nodes (including sentinel nodes) were found per patient. Of the 13 patients in whom a sentinel lymph node was identified, 10 were positive for metastases (77%). Only 4 of the 10 had further axillary metastases (40%). Three patients had negative sentinel lymph nodes shown by hematoxylin and eosin and cytokeratin stainings and had no axillary metastases (0% false negative). The single patient in whom a sentinel lymph node could not be identified had stage IIIA disease with extensive lymphatic tumor emboli. Sentinel lymph node mapping is feasible in neoadjuvant chemotherapy breast cancer patients and can spare a significant number of patients the morbidity of full axillary dissection. Further study to evaluate sentinel lymph node mapping in this patient population is warranted.     

Level III axillary lymph nodes involvement in node positive breast cancer received neoadjuvant chemotherapy

ObjectiveTo investigate the incidence, associated factors and prognosis of level III node involvement for breast cancer with positive axillary lymph nodes after neoadjuvant chemotherapy.MethodsA consecutive series of 521 node positive T_0–2 invasive breast cancer cases were included in this retrospective study. Axillary node metastases were proved by ultrasound guided needle biopsy (NB) if ultrasonographic abnormal node was detected or by sentinel node biopsy (SNB) if no abnormal node was detected. After 4 to 8 cycles of neoadjuvant chemotherapy (NCT）, axillary lymph nodes dissection included level III lymph nodes were completed for each case.ResultsThe pathologic complete response rate of axillary nodes was 31.1% (90/289) in NB positive subgroup. The incidence of residual positive level III lymph nodes were 9.0% (47/521). Multivariate analysis showed that node NB positivity (OR = 2.212, 95% CI: 1.022–4.787, P = 0.044), clinical tumor size >2 cm before NCT (OR = 2.672, 95% CI: 1.170–6.098, P = 0.020), and primary tumor non-response to neoadjuvant chemotherapy (OR = 1.718, 95% CI: 1.232–2.396, P = 0.001) were independent predictors of level III lymph nodes positivity. At median follow-up time of 30 months, the distant disease-free survival (DDFS) rate of level III node positive group was much lower than that of level III negative group (p = 0.011).ConclusionsAbout 9% of node positive T_0–2 breast cancer will have residual positive node in level III region after neoadjuvant chemotherapy. Node positivity proved by NB, large tumor size, and primary tumor non-response to neoadjuvant chemotherapy are independent predictors of level III lymph nodes positivity.     

Diagnosis of complete response to neoadjuvant chemotherapy using diagnostic imaging in primary breast cancer patients

Advances in the therapeutic agents used for neoadjuvant chemotherapy (NAC) have recently achieved higher response rates and induced a greater number of pathologic complete responses (pCR) than ever before. The aim of this study is the diagnosis of pCR after NAC by diagnostic imaging of clinical complete response (cCR) patients. This study included 35 breast cancer patients who demonstrated cCR after receiving NAC with a combination of anthracycline and taxane from May 1998 to August 2003. Surgical treatment included breast-conserving therapy followed by radiotherapy or mastectomy. The identity of post-NAC lesions as either a complete response (CR) or partial response (PR) were made by mammography, ultrasonography, and contrast-enhanced computed tomography (CT). Among the 35 patients, 11 achieved pCR, including the disappearance of both invasive and intraductal components. Of the patients achieving pCR, eight were defined as CR and three were determined to be PR by CT. There was a significant relationship between the pCR and the determination of CR by CT. The determination of CR by ultrasonography was indicative of the disappearance of pathologic invasive components. While mammography appeared to reflect the observed histologic results, we did not observe any statistical differences. A subset of cases exhibited discrepancies between the imaging and pathologic results, likely due to the replacement of destroyed tumor cells by fibrosis and granulomatous tissue. The evaluation of CR by CT was significantly indicative of pCR. The positive predictive value, however, was not large enough to avoid surgical treatment. Further studies will be needed to establish a diagnosis of pCR.     

Accuracy of axillary sentinel lymph node biopsy following neoadjuvant (induction) chemotherapy for carcinoma of the breast

Sentinel lymph node biopsy (SLNB) is widely employed to detect axillary lymph node metastases in breast cancer patients with clinically negative (N0) axillae. One of the few reported contraindications to SLNB is prior treatment with systemic chemotherapy (neoadjuvant/induction chemotherapy). Previous investigators reported difficulty identifying the sentinel node and an unacceptable false-negative rate in this patient cohort. We present one experienced surgeon's experience with SLNB following induction chemotherapy (n = 21). Following treatment with Adriamycin and Cytoxan (AC)-based cyclic chemotherapy, patients underwent SLNB, followed by levels I and II axillary lymph node dissection (ALND). At least one sentinel node was identified in all patients (100%). With respect to metastatic disease, the status of the sentinel node(s) accurately reflected the status of the axilla in 20 of 21 patients (95%). Eleven patients (52%) had axillary metastases identified by ALND. Of this group, SLNB failed to identify metastatic disease in one patient (9%). Previous treatment with induction chemotherapy should not be considered an absolute contraindication to SLNB. An experienced surgeon may utilize the technique in these patients, sparing them the added morbidity of axillary dissection.     

应变力超声弹性成像预测乳腺癌患者新辅助化疗后病理完全缓解

目的评估应变力超声弹性成像(SUE)技术预测乳腺癌患者新辅助化疗(NAC)后病理完全缓解(pCR)的效能。方法收集乳腺癌患者60例,采用SUE评估NAC前肿瘤的弹性评分和弹性应变率比值,记录肿瘤穿刺活检的免疫组化结果,术后病理参照Miller-Panye分级法评估病理反应性,采用Logistic回归分析获得影响NAC后pCR的独立影响因素。绘制不同指标预测pCR结局的ROC曲线,并计算曲线下面积(AUC),Z检验比较不同指标的AUC。结果高弹性评分是pCR的独立影响因素。弹性应变率比值的预测效能最佳,AUC为0.92±0.03,且与Ki-67(0.60±0.08)的AUC比较差异有统计学意义(P0.01);而弹性应变率比值与弹性评分(0.89±0.05)的AUC差异无统计学意义(P=0.36)。结论 SUE评估乳腺癌硬度可预测NAC后pCR结局,在乳腺癌的个体化精准治疗中有重要作用。     

Sonographic features of benign and malignant axillary nodes post‐neoadjuvant chemotherapy

The aim was to determine whether sonographic features of metastatic axillary lymph nodes predict pathologic nodal status post‐neoadjuvant chemotherapy (NCT) and help to tailor less invasive surgical management of the axilla. Patients with biopsy‐proven cN1 primary breast malignancy who received NCT between January 2011 and December 2014 and had performed ultrasound were included in this study. Sonographic features of biopsy‐proven clipped metastatic axillary nodes pre‐ and post‐NCT were retrospectively reviewed by two independent readers. Changes in lymph node shape, fatty hilum status, cortical thickness, and cortical echogenicity were compared in patients with and without nodal pathologic complete response (pCR) using univariate and multivariate logistic regression models. Inter‐reader variation was analyzed to determine the reproducibility of data. Of the 195 patients included in the study, 75 (45%) showed nodal pCR and 90 (55%) persistent metastatic disease post‐NCT. pCR was significantly more likely in lymph nodes with isoechoic or hypoechoic cortical echogenicity post‐NCT, (P = .02), conversion to normal cortical thickness (P = .0001), and oval shape (odds ratio = 0.17, P = .004), compared to lymph nodes with anechoic cortical echogenicity, persistent or diffuse cortical thickening, and irregular shape, respectively. The overall accuracy of sonographic nodal features in the prediction of pCR was 65% (95% CI: 58%‐72%). The overall accuracy of sonographic features of biopsy‐proven metastatic axillary lymph nodes post‐NCT is not sufficiently high to predict pCR of axillary nodal status and thereby should not be solely used in guiding less invasive surgical approaches to the axilla.     

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目的分析胃癌新辅助化疗后原发病灶病理学完全缓解(pathological complete response,pCR)病人的临床特征。方法筛选北京大学肿瘤医院2001—2010年间胃癌新辅助化疗原发病灶pCR的11例病人的临床资料,分析其临床特征。结果 11例病人治疗前均为局部进展期胃癌,10例应用FOLFOX类方案、1例应用SOX化疗方案。1例病人术后病理提示有淋巴结转移;FOLFOX类方案的pCR率不足5%,现临床评效手段CT及超声胃镜(EUS)对于pCR病人的评估准确率低(2/11);所有病人至今均无病生存,提示预后好。结论从pCR角度判断,目前应用的胃癌新辅助化疗方案及临床评效手段有待改良。     

乳腺癌行腋窝淋巴结清扫规范、争议与共识

乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移（cN0）的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。     

1～2枚前哨淋巴结阳性乳腺癌患者中非前哨淋巴结转移的影响因素分析

目的分析1~2枚前哨淋巴结(SLN)阳性乳腺癌患者的临床病理因素与非前哨淋巴结(nSLN)转移的关系。方法回顾性分析2012年1月至2015年12月期间广州医科大学附属第二医院乳腺外科1~2枚SLN阳性且同时行腋窝淋巴结清扫的118例早期浸润性乳腺癌患者临床病理资料,分别应用x~2检验及Logistic回归进行单因素及多因素分析。结果 nSLN未转移(nSLN-)组患者64例,nSLN转移(nSLN+)组患者54例。单因素分析显示nSLN转移与肿瘤大小、脉管癌栓、SLN转移比例有关(P=0.001,P=0.030,P=0.002),但与年龄、绝经状态、病理类型、肿瘤位置、核分级、SLN转移数目、ER、PR、C-erBb-2、Ki67无关(均P0.05)。多因素分析显示肿瘤大小、脉管癌栓、SLN转移比例均为nSLN转移的独立影响因素(OR分别为3.159,2.425,2.258,均P0.05)。结论肿瘤大小≥2 cm、脉管癌栓、SLN转移比例≥2、3均为1~2枚SLN阳性乳腺癌患者nSLN转移的独立不良影响因素。