前哨淋巴结活检在新辅助化疗乳腺癌患者中的临床研究进展

前哨淋巴结活检作为早期乳腺癌患者腋窝淋巴结分期的手段已被肿瘤学界普遍接受,而且对前哨淋巴结阴性患者可以避免腋窝淋巴结清扫术带来的不良后果。随着前哨淋巴结活检技术的发展,其适应证不断扩大,但该方法在新辅助化疗乳腺癌患者中的应用目前尚有争议。本文对新辅助化疗乳腺癌患者前哨淋巴结活检的可行生及时机选择进行综述。     

前哨淋巴结活检对早期乳腺癌患者腋窝淋巴结转移状况的预测

目的：探讨前哨淋巴结活检对早期乳腺癌患者腋窝淋巴结转移状况预测的临床应用价值。 方法：选取100例乳腺癌手术患者,应用前哨淋巴结活检判断患者腋窝淋巴结的肿瘤转移情况,并以腋窝淋巴结病理活检作为标准,对照分析前哨淋巴结活检判断早期乳腺癌患者腋窝淋巴结有否转移的准确性。 结果：前哨淋巴结病理活检预测腋淋巴结转移情况的灵敏度81.6%,特异性100%,假阴性率18.4%,假阳性率0,准确率92.9%,阳性预测值100%,阴性预测值89.7%。不同年龄的患者,所患肿瘤部位及所患肿瘤大小不同的患者,其前哨淋巴结的发现率、假阴性率和准确性均无统计学差异（P>0.05）。 结论：前哨淋巴结活检对于判断其是否有腋窝淋巴结转移有价值。     

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初步研究

目的研究乳腺癌新辅助化疗后前哨淋巴结活检（SLNB）的可行性和效果。方法利用新型示踪剂——^99mTc-利妥昔配合专利蓝染料对60例原发性乳腺癌新辅助化疗后病例进行SLNB，并对SLN进行常规病理检查和免疫组织化学检查。SLNB后常规腋窝淋巴结清扫。结果SLN检测成功率95％（57／60）。SLN转移阳性23例（40％），其中18例为常规病理检查转移阳性（78％），5例为免疫组织化学检出的微转移（22％）。23例SLN有转移病例中，9例同时存在其他腋窝淋巴结转移，另外14例为惟一转移淋巴结。1例SLN转移假阴性。灵敏度96％（23／24），准确性98％（56／57），特异度100％（33／33），假阴性率4．3％（1／23），阴性预测值97％（36／37），阳性预测值100％（24／24）。内乳淋巴结显像11例，活检病理检查均为转移阴性。结论同位素示踪剂和蓝染料联合检测方法对原发性乳腺癌新辅助化疗后进行SLNB同样适用，内乳前哨淋巴结活检不应做常规推荐。     

早期乳腺癌前哨淋巴结阳性腋窝进一步处理的探讨

目的:探讨早期乳腺癌前哨淋巴结活检结果阳性的患者是否需要进一步腋窝淋巴结清扫。方法:回顾性分析112例因前哨淋巴结活检阳性继续行腋窝淋巴结清扫术早期乳腺癌患者资料。结果:112例哨淋巴结活检阳性患者中,75例(67.0%)的腋窝淋巴结清扫后病理结果阴性。单因素分析显示,病灶大小、前哨淋巴结病理阳性个数、淋巴结外侵犯、HER-2、Ki-67、组织学分级对前哨淋巴结活检阳性继续行腋窝淋巴结病理结果有影响(均P0.05);进一步哑变量分析显示,随着病灶大小与前哨淋巴结理阳性个数的增加,腋窝淋巴结出现阳性结果的风险明显增加(均P0.05)。多因素分析显示,病灶大小、前哨淋巴结结果与Ki-67表达是腋窝淋巴结清扫术结果的独立影响因素(均P0.05)。结论:对于前哨淋巴结阳性个数1枚、病灶≤2 cm且Ki-67低表达的早期乳腺癌患者,可建议免于行腋窝淋巴结清扫术。     

超声引导针吸活检术评价乳腺癌腋窝淋巴结转移

目的 研究超声引导针吸活检在术前判断乳腺癌腋窝淋巴结转移中的应用,评价该方法的可行性和诊断的准确率. 方法对40例腋窝触诊阴性的高度可疑乳腺癌患者的40个腋窝淋巴结进行超声引导针吸活检,将结果与前哨淋巴结活检或腋窝淋巴结清扫的组织学病理结果进行对照.分析超声引导针吸活检判断乳腺癌腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率.结果 40例患者全部经病理证实为浸润性乳腺癌.超声引导针吸活检判断腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为52.2%、100%、100%、60.7%、72.5%.有12例(30%)术前细针穿刺活检阳性的患者避免了前哨活检,直接接受了腋窝清扫.结论 应用超声引导针吸活检在术前判断乳腺癌的腋窝淋巴结转移情况创伤小、特异性高,可以避免部分患者接受前哨淋巴结活检术.

Abstract：

Objective To study the utilization of preoperative ultrasound-guided fine-needle aspiration(USFNA) for axillary lymphnode(ALN) metastasis in breast cancer and to evaluate the feasibility and accuracy of the technique. Methods Forty ALNs in 40 armpit negative palpation highly suspective breast cancer patients underwent USFNA. The cytopathological results were compared with the histopathological results of sentinel lymphnode(SLN) biopsy or axillary lymphnode dissection(ALND). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of USFNA for the ALN metastasis were analysed. Results All the 40 patients were confirmed with breast cancer by pathology. Sensitivity of USFNA was 52. 2%, specificity was 100%, PPV was 100%,NPV was 60. 7% and diagnostic accuracy was 72. 5%. 12(30% ) patients with positive cytology proceeded to ALND, avoiding SLN biopsy. Conclusions USFNA is a minimally invasive, highly specified technique for prediction of breast cancer ALN metastasis before operation.     

术前腋窝超声检查预测早期乳腺癌腋窝淋巴结转移状况

探讨术前腋窝超声检查预测早期乳腺癌腋窝淋巴结转移的情况。选取85例早期乳腺癌患者,均进行了术前腋窝超声检查和前哨淋巴结活检术,比较术前腋窝超声检查结果与术中前哨淋巴结活检结果的一致性。以术后病理为标准进行分析的基础上,再以术中前哨淋巴结病理结果为标准,则术前彩超检查的真阳性结果为16例,与术中病理符合度为18.82%;真阴性结果为54例,与术中病理符合度为63.53%;总体上一致的比率或术前超声对腋窝淋巴结转移的诊断符合度为82.35%。术前腋窝超声检查对早期乳腺癌腋窝淋巴结转移有重要的参考意义。一定比例的早期乳腺癌患者可以通过术前腋窝超声检查结果直接进行腋窝淋巴结清除术,不需要术中作前哨淋巴结活检。     

前哨淋巴结活检在早期乳腺癌手术中的意义

目的探讨前哨淋巴结活检在早期乳腺癌外科治疗中决定乳腺切除范围的意义.方法278例乳腺癌患者,利用γ-探测仪定位前哨淋巴结(SLN),切下的SLN和腋窝淋巴结(ALN)行HE染色和免疫组织化学染色(IHC),观察前哨淋巴结病理结果,预测腋窝淋巴结转移的准确性.结果278例前哨淋巴结,检出率91.73%(255/278).248例进行腋窝淋巴结清扫,HE染色86例腋窝淋巴结转移,87例前哨淋巴结转移;IHC染色显示腋窝淋巴结转移91例,前哨淋巴结转移88例.60例前哨淋巴结活检阴性的早期乳腺癌保乳治疗后,随访3～5年影像学检查均未发现局部复发或腋窝淋巴结转移,保乳保腋窝组和保乳未保腋窝组远期疗效无区别.结论前哨淋巴结活检用于指导腋窝淋巴结清扫,是一种相对可靠的客观指标,活检阴性可作为保留腋窝的安全指标,但术后仍需监测腋窝淋巴结的增多或增大现象,必要时进行淋巴结活检.     

乳腺癌前哨淋巴结活检对腋窝淋巴结转移的预警价值研究

目的探讨乳腺癌前哨淋巴结(sentinel lymph node,SLN)预警腋窝淋巴结转移的价值. 方法对56例乳腺癌行亚甲蓝前哨淋巴结定位、活检和腋窝淋巴结清扫术,标本常规行HE染色、免疫组化病理检查. 结果 SLN成功检出52例(52/56,92.8%),常规病理检查证实SLN转移22例;SLN无转移,但非SLN发现转移者1例,假阴性率为4.3%(1/23).常规病理检查无转移的29例患者,免疫组化检测发现1例CK-19( )、EMA( ),另1例CK-19( ),CEA( ),而所属非前哨淋巴结无肿瘤转移. 结论乳腺癌亚甲蓝前哨淋巴结定位、活检可以预示腋窝淋巴结转移.     

乳腺癌前哨淋巴结检测的临床研究

目的通过前哨淋巴结(sentinel lymph node,SLN)活检,了解前哨淋巴结是否能反映乳腺癌腋窝淋巴结转移情况,从而决定是否行腋窝淋巴结清扫(axillary lymph node dissection,ALND). 方法 47例T1、T2、T3临床检查腋窝淋巴结无肿大的乳腺癌患者,术前30 min于乳腺肿块周围腺体注射蓝色染料,术中取蓝染的SLN病理检查,术后将病理检查结果与腋窝淋巴结转移情况进行比较分析. 结果 47例中5例未见淋巴结及淋巴管蓝染,其余42例找到腋窝淋巴结608个,阳性18例168个,阴性24例440个;SLN共78个,阳性16例29个,阴性26例49个.SLN的检出率89.4%,准确性95.2% ,特异性100%,敏感性88.9%,假阴性率11.1%,假阳性率0. 结论 SLN活检反应腋窝淋巴结的肿瘤转移状况,可以用于术中确定是否行ALND.     

Sentinel lymph node biopsy after neoadjuvant chemotherapy in a patient with operable breast cancer

PURPOSE: This study was undertaken to assess the feasibility of performing a sentinel lymph node biopsy (SLNB) for a patient with operable breast cancer after undergoing neoadjuvant chemotherapy (NAC). METHOD: Between January 2002 and December 2003, women with primary breast cancer who had a breast tumor measuring larger than 3 cm in unilateral diameter were eligible for NAC. All patients who had completed NAC underwent lymphatic mapping with labeled (99m)Tc phytate on the day before surgery. Sentinel lymph node biopsy followed by a full axillary lymph node (AXLN) dissection (ALND) was performed in all patients. Sentinel lymph nodes (SLN) were sent for a frozen-section examination. RESULTS: The rate of SLN identification was 71%. Both the sensitivity and negative predictive value of SLNB were 100%. The false negative rate was 0%. When candidates for SLNB were restricted to patients with a breast tumor measuring less than 3 cm and clinically negative nodes after NAC, the rate of SLN identification increased to 93% from 71% while still maintaining the 0% false negative rate. CONCLUSION: Sentinel lymph node biopsy after NAC is therefore considered to be a feasible and accurate method to predict the AXLN status in patients who have a breast tumor measuring less than 3 cm in unilateral diameter and a clinically negative AXLN status at the time of surgery after NAC.     

乳晕下亚甲蓝法乳腺癌前哨淋巴结活检术169例应用报告

目的探讨乳晕下注射亚甲蓝示踪法进行前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)在乳腺癌治疗中的意义。方法 2005年1月～2010年3月,对169例(年龄33～70岁,中位年龄45岁)临床腋窝淋巴结阴性的乳腺癌术中乳晕下注射亚甲蓝2 ml行SLNB。SLN病理为阴性的患者,SLNB替代腋窝淋巴结清扫术。结果 163例(96.4%)成功实施SLNB,6例(3.6%)术中未能发现SLN,立即改行腋窝淋巴结清扫术(axillary lymph node dissection,ALND)。行SLNB的163例中,23例术中冰冻报告SLN癌转移,即行ALND;140例冰冻切片检查SLN未见癌转移。6例术后HE染色检查发现SLN存在1枚微转移淋巴结,5例接受ALND,1例拒绝行腋窝淋巴结清扫。135例SLNB代替ALND者中位随访时间16个月(3～62个月),均未发现腋窝淋巴结转移。结论亚甲蓝法SLNB安全、有效、简便易行,SLNB阴性的患者,可以替代ALND。     

前哨淋巴结检测在乳腺癌治疗中的意义

目的评价前哨淋巴结活检术 (sentinellymphnodebiopsy,SLNB)预测腋淋巴结肿瘤转移的准确性及其临床意义。方法使用专利蓝染色法和 /或99mTc标记的硫胶体示踪法对我院收治的81例乳腺癌患者进行前哨淋巴结活检。两种方法联合检测 3例前哨淋巴结 (sentinellymphnode ,SLN)均阴性者未行腋淋巴结清扫术。结果 81例患者SLN总检出率为 96 3% (78/81) ,总准确率为97 5 % ,总假阴性率 9 7%。 5 3例单纯染色法检出率为 92 5 % ,准确率 94 2 % ,假阴性率 15 8% ;2 8例99mTc示踪法和 /或染色法联合检测结果分别为 10 0 % ,10 0 %和 0。结论SLNB能够准确预测腋窝淋巴结的转移状况。两种方法联合检测为最佳。术前化疗对假阴性率可能有影响。     

乳腺癌新辅助化疗后腋窝反向淋巴作图安全性研究

目的 探讨乳腺癌经新辅助化疗（NAC）后行腋窝反向淋巴作图（ARM）的可行性及安全性。方法 回顾性分析2015年1月至2018年7月蚌埠医学院第一附属医院肿瘤外科收治的行NAC达ycN0的45例乳腺癌病人的临床资料。腋窝淋巴结处理方法包括双示踪前哨淋巴结活检（SLNB）、腋窝淋巴结清扫（ALND）,其中部分病人因SLNB失败或前哨淋巴结（SLN）阳性改行ALND。所有病人术中均行亚甲蓝染料法ARM。分析术中ARM施行情况、淋巴结保留的效果及安全性。结果 ARM淋巴结保留13例,ARM淋巴结切除32例。随访截至2019年6月,随访时间为37.5（12~48）个月。ALND组和SLNB组ARM成功率分别为93.1%（27/29）和40%（8/20）。ARM淋巴结与SLN重叠3例,ARM淋巴结肿瘤转移1例。ARM淋巴结保留病人术后上肢水肿发生率显著低于ARM淋巴结切除者（P=0.010）,腋窝局部复发率差异无统计学意义（P=1.000）。结论 对于NAC后达ycN0的乳腺癌病人,术中行ARM成功率较高,ARM淋巴结肿瘤转移率低,安全可行。     

超声定位下可疑淋巴结取样在早期乳腺癌手术中的临床研究

目的 探讨早期乳腺癌更为合理的腋窝淋巴结处理方法,明确腋窝可疑淋巴结取样结合前哨淋巴结活检(SLNB)替代单纯SLNB时的假阴性率是否明显降低,为临床应用提供依据.方法 采用传统的腋窝淋巴结外科学分群方法,对符合入组条件的42例早期乳腺癌患者术前行B超引导下钩丝定位,术中行腋窝SLNB和定位的可疑淋巴结活检,再行全腋窝...     

Are the ACOSOG Z0011 Trial Findings Being Applied to Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy?

In 2010, the ACOSOG Z0011 trial showed equivalent survival and recurrence between sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) for those with a tumor positive sentinel node (SN). We examined national trends in axillary surgery following neoadjuvant chemotherapy (NAC) for clinically node positive disease in the years prior to and after the Z0011 trial publication. 12,063 women with cT1‐4N1M0 invasive breast cancer who underwent NAC from 2006 to 2013 and had 1‐3 positive nodes on pathology were selected from the National Cancer Data Base. We defined SLNB as 1–4 nodes and ALND as ≥10 nodes examined. 2,704 women (22.4%) underwent SLNB alone and 9,359 (77.6%) underwent ALND. The rate of SLNB increased from 25.6% in 2006 to 33.3% in 2012 in patients that underwent lumpectomy (p < 0.01) and increased from 20.6% to 22.8% in patients that underwent mastectomy (p = 0.25). Patients treated at Community centers (30.4% versus 19.2% at Academic centers) and those with less positive nodes (32.2% for 1 positive node versus 10.1% for 3 positive nodes, p < 0.01) were more likely to have SLNB alone compared to ALND. On multivariate analysis, treatment with lumpectomy (OR 1.46, CI 1.28–1.67), lower number of positive nodes (OR 3.98, CI 3.29–4.82) and lobular subtype (OR 1.82, CI 1.42–2.34) were independent predictors of receiving SLNB alone after NAC. Approximately 22% of patients with cN1 breast cancer underwent SLNB alone for pN1 disease after NAC. Ongoing clinical trials will determine if recurrence and survival rates are equivalent between SLNB and ALND groups.     

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。     

Lymphatic mapping in patients with breast cancer and previous augmentation mammoplasty

Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer. A retrospective study was performed from 1995 to 2006. Ten patients with augmented breasts underwent breast conservation therapy with SLNB. Sentinel lymph nodes were identified in all 10 patients. Three patients had positive sentinel nodes. Two patients proceeded to axillary lymph node dissection (ALND), and one declined. The subsequent ALND were negative for metastatic cancer. Seven patients had negative sentinel nodes. One patient with a negative sentinel node underwent ALND with all nodes negative for metastasis. Two patients were lost to follow-up. Of the remaining eight patients, the mean duration of follow-up was 71 months. None of these patients had evidence of axillary recurrence or distant metastasis at time of last follow-up. SLNB is a feasible method of axillary node staging in patients who have undergone augmentation mammoplasty who subsequently develop breast cancer. Further studies are needed to better determine the accuracy of lymphatic mapping in this patient population.     

Sentinel lymph node biopsy before versus after neoadjuvant chemotherapy for breast cancer

Axillary lymph node status is the most important prognostic factor in the treatment of breast cancer. In recent years, sentinel lymph node biopsy (SLNB) has replaced conventional axillary lymph node dissection for predicting axillary lymph node status with higher accuracy. Moreover, neoadjuvant chemotherapy (NAC) is being used increasingly to treat not only patients with locally advanced inoperative breast cancer, but also those with initially operable breast cancer. The application of SLNB has now expanded to include this patient population, who were not previously considered good candidates for SLNB. A number of recent studies have evaluated the feasibility and accuracy of SLNB after NAC in breast cancer patients. Moreover, SLNB has been shown to be accurate in patients scheduled to receive NAC, and repeat SLNB has been performed after NAC for patients with positive nodes detected by the initial SLNB before NAC. Thus, the optimal timing of SLNB for patients with breast cancer in the neoadjuvant setting remains controversial. This article reviews the issues surrounding SLNB before vs. after NAC, according to the published literature and our experience.     

Sentinel Lymph Node Biopsy for Breast Cancer: Current Controversies

Abstract:   Sentinel lymph node biopsy (SLNB) has replaced the routine level I and II axillary lymph node dissection (ALND) for women with clinically node-negative T1 and T2 breast cancer. Studies have shown that SLNB is highly predictive of axillary nodal status with a false-negative of rate less than 10%. Our purpose was to address some of the ongoing controversies about this procedure, including technical issues, use of preoperative lymphoscintigraphy, internal mammary lymph node biopsy, criteria for patient selection (in intraductal carcinoma?), its staging accuracy, and the clinical approach when a SLNB was found to be negative or positive on pathologic examination. After the revision of the American Joint Committee on Cancer (AJCC) staging system for breast cancer in 2002, the evaluation of internal mammary lymph nodes and determination of micrometastases by hematoxylin-eosin or by immunohistochemistry have become increasingly important in staging of patients. Recent guideline recommendations developed by the American Society of Clinical Oncology (ASCO) Expert Panel in 2005 are also discussed. Long-term follow-up results of ongoing studies will provide more accurate assessment of the prognostic significance of SLNB and its value in the prevention of breast cancer-related morbidity in axillary staging compared to ALND.