腋窝淋巴结阳性乳腺癌新辅助化疗后腋窝治疗选择的研究

目的:分析腋窝淋巴结(axillary lymph node,ALN)阳性乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)后经前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)评估ALN状态的可行性,并探讨腋窝的后续治疗选择。方法:回顾性分析2016年1月至2018年1月天津医科大学肿瘤医院收治的82例ALN阳性乳腺癌患者的临床资料,均NAC后行SLNB,评估其检出率、准确率、假阴性率(false negative rate,FNR)并对可能影响因素进行分层分析。结果:82例患者腋窝病理完全缓解(pathological com-plete response,pCR)43例、占52.4%,SLNB检出率为97.56%(80/82),准确率为88.75%(71/80),FNR为23.08%(9/39)。前哨淋巴结(sentinel lymph node,SLN)检出数目为1、2枚和数目≥3枚时,FNR分别为20.0%(2/10)、71.4%(5/7)和9.1%(2/22),准确率分别为90.9%(20/22)、66.7%(10/15)和95.3%(41/43),差异具有统计学意义(均P<0.05)。结论:ALN阳性乳腺癌患者NAC后行SLNB总体FNR较高,尚未达到临床可接受范围,不能完全取代腋窝淋巴结清扫(axillary lymph node dissection,ALND),SLN检出数目≥3枚时SLNB可准确评估ALN状态。

Therapeutic choice of axillary treatment after neoadjuvant chemotherapy in patients with node-positive breast cancer

  Objective  To analyze the feasibility of axillary lymph node staging through sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in patients with node- positive breast cancer and to explore the follow- up treatment of these patients.  Methods   Clinical data of 82 patients with node-positive breast cancer before NAC in Tianjin Medical University Cancer Institute and Hospital from January 2016 to January 2018 were analyzed retrospectively. All these patients accepted SLNB after NAC. The detection rate, accuracy, false negative rate (FNR), and influencing factors were analyzed.  Results  A nodal pathological complete response (PCR) was achieved in 43 of 82 patients. The PCR rate was 52.4%. The detection rate, accuracy, and FNR were 97.56% (80/82), 88.75% (71/ 80), and 23.08% (9/39), respectively. The accuracy of 1, 2, and ≥3 SLNs detected were 90.9% (20/22), 66.7% (10/15), and 95.3% (41/ 43), respectively. The FNRs were 20.0% (2/10), 71.4% (5/7), and 9.1% (2/22), respectively (both P < 0.05).  Conclusions  Due to its overall high FNR, without clinically acceptable limits, post-NAC SLNB cannot completely replace axillary lymph node dissection (ALND) in nodepositive patients. However, with no less than 3 SLNs detected, SLNB can accurately evaluate the status of axillary lymph nodes.