腋窝淋巴结阳性乳腺癌患者新辅助化疗后前哨淋巴结活检研究

目的 探讨腋窝淋巴结阳性乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)后行前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的可行性.方法 回顾性分析本科2012至2014年间收治的69例乳腺癌患者,均经细针穿刺细胞学或空芯针穿刺活检证实为腋窝淋巴结阳性,在NAC后,以亚甲兰染色法行SLNB,后行腋窝淋巴结清扫(axillary lymph node dissection,ALND);所有淋巴结标本均采用常规石蜡包埋并连续切片、HE染色.结果 NAC后腋窝淋巴结病理完全缓解(pathologicalcomplete response,PCR)率为26.06％(18/69),SLNB检出率为88.41％(61/69),假阴性率为7.84％(4/51),准确率为93.44％(57/61).NAC前初始cN1期者与cN2期者相比,检出率(95.34％比76.92％)、假阴性率(2.86％比18.75％)差异均有统计学意义(均P＜0.05).SLN检出个数1枚、2枚、≥3枚者假阴性率和准确率分别为33.33％和75.00％、33.33％和66.67％、4.44％和96.30％,相比差异均有统计学意义(均P＜ 0.05).SLN检出率及假阴性率与原发肿瘤大小、临床化疗反应情况、病理类型及术后病理情况无明显相关性.结论 腋窝淋巴结阳性患者经过NAC后行SLNB,检出率及假阴性率可以接受,可以考虑在NAC后行SLNB确定腋窝淋巴结的状态,决定腋窝淋巴结是否需要清扫.

Sentinel lymph node biopsy in breast cancer patients positive axillary lymph node after neoadjuvant chemotherapy

Objective To explore the feasibility of sentinel lymph node biopsy (SLNB) in breast cancer patients positive in axillary lymph node after neoadjuvant chemotherapy (NAC).Methods 69 patients with breast cancer treated at our hospital from 2012 to 2014 were retrospectively analyzed.All the patients were confirmed as positive in axillary lymph node by fine needle aspiration cytology or tubular needle biopsy.SLNB was carried out using methylene blue dye after NAC;then axillary lymph node dissection was carried out.All the specimens of lymph nodes were embedded with paraffin and done serial section and HE staining.Results The pathological complete response (PCR) rate of axillary lymph nodes after NAC was 26.06％ (18/69).The detection rate of SLNB was 88.41％ (61/69).The false negative rate was 7.84％ (4/51).The accuracy was 93.44％ (57/61).There were statistical differences in the detection rate (95.34％ vs.76.92％,P=0.021) and false negative rate (2.86％ vs.18.75％,P=0.050) between patients initially in cN1 and in cN2 before NAC.The false negative rates and accuracies in the patients with 1,2 and ≥3 SLNs were 33.33％ and 75％,33.33％ and 66.67％,and 4.44％ and 96.30％,with statistical differences (P=0.047,P=0.04).The detection rate and false negative rate of SLNB has no obvious correlation with primary tumor size,clinical chemotherapy reaction condition,pathological type,and postoperative pathological condition.Conclusions The detection rate and false negative rate of SLNB in patients positive in axillary nodes after NAC are acceptable,so it is considerable to perform SLNB after NAC to confirm the axillary node status and determine whether axillary lymph node need whole resection.