新辅助化疗后乳腺癌的临床病理学改变

目的 旨在观察局部进展期乳腺癌新辅助化疗的临床病理学改变。方法 局部进展期乳腺癌40例术前用粗针穿刺获组织学检查证实为乳腺癌，并作免疫组化进行ER、PR、cerb-B2、p53、Ps2、nm23、CathD等项目检测，新辅助化疗采用TA化疗方案，3周为一个周期，完成2-6周期不等进行临床评价疗效。对术后标本进行HE、免疫组织化学染色观察。结果总有效率(RR)为90．0％(36／40)，13例(32．5％)临床完全缓解(cCR)，23例(57．5％)部分缓解(PR)，4例(10．0％)无变化(NC)，无进展病例。其中9例(22．5％)病理完全缓解(pCR)。行保乳手术10例(10140)。与术前病理检验标本比较，乳腺癌化疗后出现瘤体缩小变软、甚至消失，肿瘤细胞退变坏死、间质水肿、玻璃样变性、血管周围炎症细胞浸润及纤维化等改变；相应病例腋窝淋巴结转移灶亦有上述改变，而且淋巴结无论有无转移均可见结构改变，淋巴细胞松散，正常滤泡结构消失，甚至于出现正常淋巴结不见的充血现象，有大量噬细胞反应。免疫组织化学未见P53、cerb-B2、CathD蛋白阳性表达变化，ER、PR表达无显著差异。结论 TA新辅助化疗对多数乳腺癌的原发灶及腋窝淋巴结转移灶均不同程度变性坏死，增加了保乳手术机会，同时在抑制乳腺癌微转移灶、降低复发及转移等方面具有重要临床意义。     

TP/TC方案新辅助化疗对原发性上皮性卵巢癌ER-CC1、BRCA1及β-tubulinⅢ表达的影响

目的:探讨原发性上皮性卵巢癌患者紫杉醇+铂类(TP/TC)方案的新辅助化疗对核苷酸切除修复交叉互补基因1(ERCC l)、乳腺癌易感基因1(BRCA l)及β-微管蛋白Ⅲ(β-tubulinⅢ)表达的影响及临床意义。方法:应用免疫组化技术检测48例原发性上皮性癌患者组织标本(其中以TP/TC方案行新辅助化疗15例)中ERCC l、BRCA l及β-tubulinⅢ蛋白表达。结果:ERCCl蛋白主要在卵巢癌细胞核表达,细胞浆有少量表达;BRCAl蛋白在细胞核表达;β-tubulinⅢ在细胞胞浆中表达。新辅助化疗组中ERCC1蛋白高表达率(66.67%)显著高于术前未行化疗组(30.30%),差异有统计学意义(P0.05);新辅助化疗组中BRCA1蛋白高表达率(20%)高于术前未行化疗组(3.03%),但差异无统计学意义(P0.05);新辅助化疗组中β-微管蛋白Ⅲ高表达率(60%)高于术前未行化疗组(57.58%),但差异无统计学意义(P0.05)。结论:含铂新辅助化疗可能通过诱导ERCC1的表达增加卵巢上皮癌对铂类的耐药性。TP/TC新辅助化疗可能上调BRCA1及β-tubulinⅢ蛋白在卵巢上皮癌中的表达。     

Ⅲ期浆液性卵巢癌存活及复发相关因素分析

目的　探讨影响Ⅲ期浆液性卵巢癌存活及复发的相关因素。方法　回顾性分析 1 982年 1月～2 0 0 2年 6月在我院住院治疗的Ⅲ期浆液性卵巢癌患者的临床资料 ,比较年龄、不同FIGO亚期、病理分级、肿瘤细胞减灭术后残留肿瘤大小、盆腔及腹主动脉旁淋巴结状况及不同化疗情况的缓解率、缓解后的复发率及 3年、5年存活率。结果　 5 8例患者中 ,完全缓解 34例 ,部分缓解 8例 ,未缓解 1 6例。化疗≥ 6疗程者完全缓解率74 % ,<6疗程者无 1例完全缓解 ,二者之间差异有极显著性 (P <0 0 1 ) ;残留肿瘤直径 <2cm者 ,完全缓解率 80 % ,残留肿瘤直径≥ 2cm者 ,完全缓解率 4 7% ,二者之间差异有显著性 (P <0 0 5 ) ;盆腔及腹主动脉旁淋巴结无转移者完全缓解率 93% ,有转移加未切除者完全缓解率 4 7% ,二者之间差异有显著性 (P <0 0 1 )。多因素Logistic回归分析显示 :化疗和淋巴结状况是决定能否完全缓解的重要因素 ;影响 3年生存率及 5年生存率的主要因素首先是化疗 ,其次为淋巴结是否切除及是否转移。去掉淋巴结因素后Logistic回归分析显示 ,化疗是决定能否完全缓解的重要因素 ,影响 3年生存率的主要因素是化疗 ,影响 5年生存率的主要因素首先是化疗 ,其次为残留肿瘤大小。 34例完全缓解病例中 ,1 8例 (5 2 94 % )     

ⅠB2期和ⅡA2期子宫颈腺癌及腺鳞癌新辅助化疗后手术治疗疗效观察

目的探讨ⅠB2期和ⅡA2期子宫颈腺癌及腺鳞癌患者新辅助化疗后手术治疗的近期疗效、生存状况并分析其预后影响因素。方法回顾性分析2010年1月至2017年12月,在首都医科大学附属北京妇产医院和北京市通州区妇幼保健院接受新辅助化疗后行根治性子宫切除术治疗的ⅠB2和ⅡA2期子宫颈腺癌和腺鳞癌患者的临床资料,共48例。评价新辅助化疗的近期疗效,分析5年无进展生存期(PFS)及总生存率(OS),并分析影响患者预后的相关因素。结果 (1)新辅助化疗的有效率(完全缓解+部分缓解)(CR+PR)为66.7%(32/48);无效率(疾病稳定+疾病进展)(SD+PD)为33.3%(16/48)。(2)患者5年PFS及总生存率(OS)分别为74.2%和78.3%。其中新辅助化疗有效组与无效组5年PFS分别是86.8%和49.2%(P=0.005),有效组和无效组的5年OS分别86.7%和61.9%(P=0.03),差异均有统计学意义。新辅助化疗有效组与无效组子宫颈间质浸润深度≥1/2发生率、复发率比较,差异均有统计学意义(P0.05)。(3)术后盆腔淋巴结阳性、淋巴脉管间隙浸润(LVSI)、子宫颈深部间质受侵是影响ⅠB2、ⅡA2期的子宫颈腺癌和腺鳞癌预后的危险因素。结论ⅠB2和ⅡA2期子宫颈腺癌和腺鳞癌采用新辅助化疗后手术的治疗方法,治疗有效者长期生存率高。新辅助化疗前肿瘤最大径线≥5cm、肿瘤最大径线≥4cm、术后子宫颈深部间质浸润、盆腔淋巴结阳性、LVSI等危险因素的患者预后较差。     

新辅助化疗后乳腺癌病理变化31例分析

目的研究乳腺癌新辅助化疗后的病理改变，及其对于预后判断和后续治疗的意义。方法31例局部进展期乳腺癌患者，以TA方案进行新辅助化疗，化疗前的粗针穿刺标本和化疗后的根治术标本均进行病理检测。结果新辅助化疗后，原发病灶与淋巴结出现蜕变坏死、钙化、玻璃样变性、纤维性变等改变；临床体检、B超及钼靶评价新辅助化疗的疗效与病理评价的符合率分别为58.1%、71.0%和51.6%；新辅助化疗后原发肿瘤病理缓解程度高的患者转移淋巴结数目低于病理缓解程度低的患者（P=0.009）。结论①临床评价（体检、超声或钼靶）不能准确体现病灶在新辅助化疗后的变化；②新辅助化疗后原发肿瘤的病理评价可以在一定程度上预测腋窝淋巴结状态。     

乳腺癌激素受体的表达与新辅助化疗疗效的相关性

目的 研究乳腺癌雌孕激素受体的表达与新辅助化疗疗效之间的相关性。方法 用免疫组化的方法检测46例乳腺癌患者在接受新辅助化疗之前雌孕激素受体的表达情况，新辅助化疗结束后进行疗效评价。结果 46例患者中，临床完全缓解(cCR)17例，部分缓解(PR)21例，无变化(NC)8例，其中病理完全缓解(pCR)9例，总有效率为82．6％，pCR率为19．57％。在受体双阴的22例患者中，20例有效(cCR PR)，总有效率为90．9％，NC2例；pCR6例(27．3％)，受体单阳或双阳的2，4例患者中，18例有效(cCR PR)，总有效率为75．0％，NC6例。pCR3例(12．5％)。受体双阴组患者的pCR率及总有效率都高于受体单阳或双阳组患者，但未见显著性差异。结论 受体双阴的患者可能较受体单阳或双阳的患者对化疗的敏感性更高。     

原发性卵巢恶性苗勒管混合瘤10例临床和病理分析

目的:分析原发性卵巢恶性苗勒管混合瘤(OMMMT)的临床和病理特点,以期提高诊治水平。方法:回顾性分析收集的10例OMMMT患者临床和病理资料,对其年龄、临床症状、血清CA125水平、手术分期、残留病灶、病理结果、化疗方案、化疗反应率、药物不良反应和生存情况进行分析。结果:OMMMT患者平均年龄60.1岁,主要临床表现是腹胀、腹痛和腹部包块。血清CA125均升高。Ⅱ期1例,Ⅲ期8例,Ⅳ期1例。所有患者首先接受肿瘤细胞减灭术,5例无肉眼残留,3例残余病灶<2cm,2例残留病灶>2cm。病理检查上皮癌成分有子宫内膜样腺癌、浆液性腺癌和透明细胞癌;肉瘤成分同源性7例,异源性2例,同源性和异源性同时存在1例。所有患者术后均接受了以铂类为基础的联合化疗。7例采用紫杉醇+卡铂/顺铂方案化疗,完全缓解率是71.4%(5/7),总反应率是85.7%(6/7),仅2例出现Ⅲ度以上骨髓抑制;1例采用异环磷酰胺+多柔比星+顺铂方案化疗,获得完全缓解,但出现Ⅳ度骨髓抑制;2例经济条件差的患者采用环磷酰胺+多柔比星+顺铂方案化疗,获得完全缓解,药物不良反应轻微。随访复发3例,8例患者存活(3例带瘤生存,5例无瘤生存),1例死亡,失访1例。结论:OMMMT患者年龄大、分期晚,确诊依靠病理检查。治疗原则参照卵巢上皮性癌的治疗方案,首选肿瘤细胞减灭术,紫杉醇+铂类为基础的联合化疗作为一线化疗方案,异环磷酰胺+顺铂作为二线化疗方案。     

新辅助化疗在Ⅰb2和Ⅱa期宫颈癌治疗中的疗效观察

目的:探讨术前新辅助化疗(NACT)联合手术治疗Ⅰb2和Ⅱa期宫颈癌的疗效及不良反应。方法:回顾分析2011年1月至2013年7月于浙江中医药大学第一临床医学院治疗的107例组织病理学诊断为Ⅰb2和Ⅱa期宫颈癌患者的临床资料,其中新辅助化疗联合手术组47例,直接手术组60例。观察新辅助化疗组的疗效及不良反应,比较两组的手术时间、术中出血量、并发症、术后病理、生存情况等。结果:新辅助化疗组的化疗总有效率为59.57%,其中Ⅰb2、Ⅱa1、Ⅱa2期的总有效率分别为63.6%、57.1%和54.5%,3组差异无统计学意义(P0.05)。新辅助化疗组、直接手术组的手术时间分别为(2.99±0.13)h、(3.94±0.31)h,术中出血量分别为(449.20±50.91)ml、(587.40±45.25)ml,两组差异均有统计学意义(P0.05)。两组的手术并发症发生率分别为17.00%、18.33%,差异无统计学意义(P0.05)。新辅助化疗组、直接手术组的宫颈深肌层浸润发生率分别为19.15%、43.33%,脉管癌栓发生率分别为10.64%、26.67%,盆腔淋巴结转移发生率分别为27.66%、48.33%,两组比较差异均有统计学意义(P0.05);两组的阴道切缘阳性发生率分别为0.00%、8.33%,宫旁浸润的发生率分别为0.00%、6.67%,差异均无统计学意义(P0.05)。新辅助化疗组的不良反应主要有骨髓抑制、胃肠道反应、周围神经病变、全身或局部肌肉关节疼痛等,程度均在0~Ⅱ度,经对症治疗后均缓解。新辅助化疗组、直接手术组3年的总体生存率(OS)分别为87.23%、83.33%,无瘤生存率(DFS)分别为80.85%、78.33%,两组差异无统计学意义(P0.05)。结论:术前新辅助化疗治疗Ⅰb2和Ⅱa期宫颈癌疗效确切,降低了手术难度、高危病理因素发生率,且不良反应轻、手术并发症少,在临床上值得推广应用。     

奥沙利铂、顺铂分别联合多西他赛用于局部晚期宫颈癌根治术前新辅助化疗的临床研究

目的:比较奥沙利铂(OXA)联合多西他赛(DTX)与顺铂(DDP)联合DTX用于Ⅰ B2～ⅡB期局部晚期宫颈癌患者行根治性手术前新辅助化疗的疗效和毒副反应.方法:选择2009年2月至2010年12月江西省人民医院收治的Ⅰ B2～ⅡB期局部晚期宫颈癌患者65例,随机分为研究组(35例)和对照组(30例).研究组采用OT方案(OXA 130 mg/m2+ DTX 75 mg/m2);对照组采用PT方案(DDP 60 mg/m2+ DTX 75 mg/m2),每组在根治性子宫切除术前各行新辅助化疗2个周期,并比较两组新辅助化疗的疗效、毒副反应及术后切除子宫标本的病理组织检查情况.结果:①研究组化疗的有效率(97.1％)与对照组(96.7％)比较,差异无统计学意义(P＞0.05).②新辅助化疗毒性反应:研究组WBC减少(Ⅱ度)发生率(5.7％)和N减少(Ⅱ度)发生率(15.7％)均低于对照组(18.3％和31.7％)(P＜0.05);研究组脱发、恶心呕吐和肾脏毒性反应(Ⅰ度和Ⅱ度)发生率均明显低于对照组(P＜0.05);研究组外周神经毒性反应率(Ⅰ度和Ⅱ度)(28.6％和20.0％)均明显高于对照组(6.7％和0)(P＜0.05).③两组术后标本病理组织检查:病理完全缓解率和理想的病理反应率及宫颈间质浸润、宫旁浸润、外科切缘阳性率等方面比较,差异均无统计学意义(P＞0.05).结论:OXA+DTX与DDP+ DTX两种新辅助化疗方案对局部晚期宫颈癌均有明显效果,OXA+ DTX方案总体毒性反应低于DDP+ DTX方案,明显改善患者在化疗期间的生活质量.     

RRM1表达与宫颈鳞癌新辅助化疗敏感性的关系

目的:研究核糖核苷酸还原酶M1(RRM1)在宫颈鳞癌中的表达及与新辅助化疗敏感性的关系。方法:运用免疫组织化学PV-6000二步法,检测40例接受新辅助化疗的宫颈鳞癌患者中RRM1的表达,与临床病理参数及与新辅助化疗敏感性的关系。结果:(1)新辅助化疗前,RRM1基因的表达率为40.0%(16/40),低分化者RRM1表达较中高分化者高(χ2=5.625,P=0.018),RRM1的表达与患者的绝经状态、高危型HPV感染、FIGO分期、淋巴结转移无关;(2)新辅助化疗后耐药组RRM1基因的表达率为87.5%(14/16),高于新辅助化疗前(56.2%),差异有统计学意义(χ2=4.038,P=0.044);(3)新辅助化疗前RRM1阳性组的化疗有效率为37.5%(6/16),RRM1阴性组的有效率为75.0%(18/24),差异有统计学意义(χ2=5.625,P=0.018)。结论:RRM1基因的表达与组织学分级有关,新辅助化疗可能上调RRM1基因的表达水平,RRM1有望成为预测宫颈癌新辅助化疗疗效的指标。     

Ultrasound-guided fine needle aspiration cytology in staging clinically node-negative invasive breast cancer

The aim of this study was to evaluate the value of ultrasound (US)-guided axillary lymph node fine needle aspiration cytology (FNAC) in staging clinically node-negative invasive breast cancer. Based on retrospective data, we analyzed sensitivity, specificity, and positive and negative predictive value and efficacy of preoperative axillary US-guided FNAC. A total of 108 consecutive female patients with histological-confirmed invasive breast cancer between January 2006 and December 2010 were included. The management decisions were based on cytological results. Twenty-two patients underwent neoadjuvant chemotherapy and 86 remaining patients benefited of primary surgery. Patients with positive cytology or included in neoadjuvant regimens were scheduled for axillary lymph node dissection (ALND), while patient with negative or nondiagnostic cytology underwent sentinel lymph node biopsy. Axillary US-guided FNAC was compared with definitive pathology of surgically removed lymph nodes. Axillary metastases were found in 55 out of 108 patients (50.9%). In these cases we proceeded with ALND. Excluding the group benefiting from neoadjuvant chemotherapy, we could spare a second surgical intervention for 37 out of 86 patients (43%). The axillary US with FNAC has a sensitivity of 73%, a specificity of 85%, a positive predictive value of 89%, and a negative predictive value of 66%. Without taking into account the neoadjuvant chemotherapy group, in which the statistical analyzes might be biased by the complete histological response, specificity and positive predictive value increased to 100% and negative predictive value to 71%. US combined with FNAC of axillary lymph nodes is a simple, minimally invasive, and reproducible diagnostic approach in improving the preoperative axillary staging of invasive breast cancer patients.     

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+ _CNB stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy. Key words: breast cancer, neoadjuvant chemotherapy, sentinel LNE, targeted axillary dissection     

Sentinel lymph node biopsy in breast cancer patients--results and experience after 500 sentinel lymph node biopsies

INTRODUCTION: Sentinel lymph node biopsy (SLNB) is a widely used technique for axillary staging in breast cancer patients. The principle to evaluate the axillary status of a breast cancer patient with a less invasive surgery than axillary lymph node dissection (ALND) meets the new minimally invasive concept in breast cancer surgery. Some breast cancer centers proceed to SLNB without ALND in SLN-negative patients. PATIENTS AND METHODS: Between March 1998 and March 2002, 500 SLNBs were performed. After a learning period with SLNB and ALND in 75 patients with a sensitivity of 96.2% and a false-negative rate of 3.8%, SLNB alone without further ALND was performed in a group of patients. In addition, the feasibility of SLNBin patients with locally advanced breast cancer, in patients after neoadjuvant chemotherapy and in patients with multicentricity was evaluated. The combined method with blue dye and technetium-99m-labeled human albumin for identification of SLNs was applied. RESULTS: 500 SLNBs were performed. The identification rate was 86.2%. After exclusion of patients with neoadjuvant chemotherapy and patients with multicentricity, the identification rate was 94.5%. SLNs were positive in 41.3% of patients and negative in 58.7% of patients. DISCUSSION: SLNB is an excellent method for axillary stag-ing and an alternative for ALND in a certain group of breast cancer patients.     

Targeted Removal of Axillary Lymph Nodes After Carbon Marking in Patients with Breast Cancer Treated with Primary Chemotherapy

In breast cancer patients who have received primary chemotherapy and then no longer have any suspicious lymph nodes clinically and/or on imaging, marking of initially suspicious axillary lymph nodes with targeted removal has recently been discussed and practised both in Germany and internationally as an alternative to complete axillary lymph node dissection. Tattooing of the suspicious lymph nodes with a highly purified carbon suspension is currently being investigated in clinical studies. Compared with other techniques, the advantages of this method are the high rate of intraoperative lymph node detection, avoidance of an immediately preoperative localisation procedure and the low costs. The practical aspects of lymph node tattooing and the current data regarding this method will be described.Key words: breast cancer, lymph nodes, carbon marking, primary chemotherapy, targeted axillary dissection, TAD     

Sentinel lymph node in breast cancer

PURPOSE OF REVIEW: Sentinel lymph node biopsy has become an accepted standard in staging axillary lymph nodes for breast cancer, but there are still unresolved questions regarding the application of the sentinel node procedure. The purpose of this review is to highlight recent developments in sentinel lymph node biopsy for breast cancer. RECENT FINDINGS: Recent evidence has demonstrated that subareolar injection immediately before surgery is an acceptable and accurate alternative to peritumoral injection, and that lymphoscintigraphy is not always necessary. The use of sentinel lymph node biopsy with neoadjuvant chemotherapy and ductal carcinoma in situ continues to undergo investigation. Recently completed clinical trials will answer questions relating to the value of identifying isolated tumor cells in the sentinel node by immunohistochemistry, and the need for axillary node dissection when the sentinel node is positive. SUMMARY: Sentinel lymph node biopsy is an accepted standard for stage I and II breast cancer, and is investigational with stage III cancer or with neoadjuvant therapy, as well as with ductal carcinoma in situ. Patients should be made aware of relevant issues as part of providing informed consent for surgery and subsequent therapy.     

Ten-year survival of patients with locally advanced, stage ib-iib cervical cancer after neoadjuvant chemotherapy and radical hysterectomy.

OBJECTIVE(S). The aim of this study was to evaluate the effects of neoadjuvant chemotherapy and radical hysterectomy on long-term survival in stage IB-IIB locally advanced cervical cancer by conducting a 10-year follow-up. METHODS: Between August 1983 and May 1990, 80 locally advanced, stage IB-IIB cervical cancer patients with tumor diameter greater than or equal to 4 cm were treated with neoadjuvant VBP chemotherapy (cisplatin, vinblastine, and bleomycin) followed by radical hysterectomy with pelvic lymphadenectomy. After this therapeutic modality, patients were followed for more than 10 years. Ten-year survival rates and factors affecting recurrence after this therapy were evaluated. RESULTS: Of 80 patients, 75 (93.7%) showed a reduction in tumor size after neoadjuvant chemotherapy. At pathologic examination, stage reduction was noted in 53 (66.2%) patients and 20 patients (25%) showed no residual or microinvasive cervical tumor. Pelvic lymph node metastases were found in 17 patients (21.3%). During the 10-year follow up, 2 patients were lost and 16 patients recurred. Overall 5-year and 10-year disease-free actual survival rates were 82.0 (64/78) and 79.4% (62/78), respectively. Clinical stage, initial tumor size, clinical response, and residual tumor size were not risk factors for recurrence after this therapy. However, pelvic lymph node metastasis was a significant risk factor for recurrence. CONCLUSION(S). Neoadjuvant VBP chemotherapy followed by radical hysterectomy in locally advanced, stage IB-IIB cervical cancer patients seemed to improve the long-term survival rate for these patients compared to that of conventional therapy. However, randomized controlled trials are needed to confirm this result.     

Detection of axillary metastases in breast cancer patients using ultrasound and colour Doppler combined with fine needle aspiration cytology

The aims of this study were to evaluate the diagnostic value of ultrasonography and colour Doppler combined with fine needle aspiration (FNA) cytology for the detection of non-palpable axillary lymph node metastases in breast cancer patients. Forty patients with operable breast cancer (T1/T2), invasive carcinoma, not submitted to neo-adjuvant therapy, underwent axillary ultrasonography and colour Doppler preoperatively. FNA cytology was performed on axillary lymph nodes presenting ultrasonographic and/or Doppler suspicious features. A total of 542 lymph nodes were surgically removed from the 40 patients; 19 were metastatic lymph nodes. Ultrasound-guided FNA detected metastases in six out of 11 histologically node-positive patients. Sensitivity and specificity in this preliminary study was 55% and 100%, respectively. These are the preliminary results of a prospective study that has the purpose of reducing the sentinel node procedures in breast cancer patients with clinically negative axillae, but positive FNA cytology.     

Limitations of sentinel lymph node biopsy in breast cancer

Sentinel lymph node biopsy is a widely accepted new surgical procedure in the treatment of early breast cancer. However, not only numerous details of the technique, but also limitations of the method, such as maximal tumor size, multifocal disease, accuracy following neoadjuvant chemotherapy and appropriateness in ductal carcinoma in situ are being debated. Recent multicenter studies could establish the lower morbidity of sentinel lymph node biopsy compared to axillary clearance as well as the false-negative rate which lies between 7 and 9.7%. In unifocal T1 disease with clinically negative axillary lymph nodes, the method is considered to be standard of care. Evidence is growing that it may also be appropriate in larger and multifocal tumors while the method is unreliable after neoadjuvant chemotherapy.