乳腺癌新辅助化疗后前哨淋巴结活检的临床意义

目的探讨新辅助化疗后乳腺癌前哨淋巴结活检的可行性。方法对57例行^99Tc联合亚甲蓝示踪前哨淋巴结活检术和腋窝淋巴结清扫术乳腺癌患者的资料进行分析，其中31例ⅡB、Ⅲ期患者先行2～3个疗程新辅助化疗后再行前哨淋巴结活检及腋窝淋巴结清扫术，另26例Ⅰ、Ⅱ期患者直接行前哨淋巴结活检及腋窝淋巴结清扫术。结果新辅助化疗组和非新辅助化疗组平均腋窝淋巴结数、前哨淋巴结（sentinel lymph node，SLN）数、SLN检出率、SLN假阴性率均无显著差异（P均〉0．05）。新辅助化疗纽化疗前临床分期在N2以上者，SLN检出率均显著下降（P〈0．05）。结论新辅助化疗后前哨淋巴结活检能准确预测腋窝淋巴结的状况。化疗前的N分期是SLNB检出率的影响因素。

The Clinical Significance of Axillary Sentinel Lymph Node Biopsy in Breast Cancer Patients after Neoadjuvant Chemotherapy

Objective To investigate feasibility of sentinel lymph node biopsy for breast cancer patients after neoadjuvant chemotherapy. Methods Sixty seven breast cancer patients underwent sentinel lymph node biopsy （SLNB） using ^99Tc combining methylene blue dye as tracer and axillary lymph node dissection （ALND） were retrospectively reviewed. Thirty one of the patients staging ⅡB and Ⅲhad SLNB and ALND after 2 - 3 circles neoadjuvant chemotherapy, another 26 patients staging Ⅰand Ⅱhad directly SLNB and ALND without neoadjuvant chemotherapy. Results The number of axillary lymph nodes, sentinel lymph nodes, identification rate and false negative rate in breast cancer patients with neoadjuvant chemotherapy were not significantly different from early breast cancer patients without neoadjuvant chemotherapy （ all P 〉 0.05 ）. In additional,in neoadjuvant chemotherapy group,the identification rate in the cases of N2 stage were lower than in N0-1 stage significantly（ P = 0.012 ）. Conclusion The SLNB can accurately predict lymph node status of axillary lymph node in patients with neoadjuvant chemotherapy. Clinical N stage is a predictor to the identification rate of SLND in the patents.