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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2012, Vol. 08 ›› Issue (06) : 725 -728. doi: 10.3877/cma.j.issn.1673-5250.2012.06.013

所属专题： 文献；

论著

乳腺癌新辅助化疗后前哨淋巴结活检的临床应用价值
郑爱秋1,*,*(), 刘瑞霞2, 朱运添1, 周颉1, 刘敏1, 石剑1, 傅建民1   
  1. 1. 518028　深圳，南方医科大学附属深圳市妇幼保健院乳腺甲状腺科
    2. 深圳市人民医院龙华分院
  • 收稿日期:2012-07-01 修回日期:2012-11-07 出版日期:2012-12-01
  • 通信作者: 郑爱秋

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

Ai-qiu ZHENG1(), Rui-xia LIU2, Yun-tian ZHU1, Jie ZHOU1, Min LIU1, Jian SHI1, Jian-min FU1   

  1. 1. Department of Breast, Shenzhen Maternal and Child Health Hospital, Southern Medical University, Shenzhen 518028, Guangdong Province, China
  • Received:2012-07-01 Revised:2012-11-07 Published:2012-12-01
  • Corresponding author: Ai-qiu ZHENG
  • About author:
    (Corresponding author: ZHENG Ai-qiu, Email: )
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郑爱秋, 刘瑞霞, 朱运添, 周颉, 刘敏, 石剑, 傅建民. 乳腺癌新辅助化疗后前哨淋巴结活检的临床应用价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2012, 08(06): 725-728.

Ai-qiu ZHENG, Rui-xia LIU, Yun-tian ZHU, Jie ZHOU, Min LIU, Jian SHI, Jian-min FU. Clinical Significance of Axillary Sentinel Lymph Node Biopsy in Breast Cancer Patients After Neoadjuvant Chemotherapy[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2012, 08(06): 725-728.

目的

探讨新辅助化疗后乳腺癌前哨淋巴结活检(SLNB)的临床应用价值。

方法

收集2010年6月至2012年6月于本院行改良根治术或保乳术的乳腺癌患者42例(ⅡB期为28例，ⅢA期为10例，ⅢB期为4例)为研究对象，对其行亚甲蓝示踪SLNB和腋窝淋巴结清扫术(ALND)后进行分析。患者先行4～6个疗程新辅助化疗(CEF方案或TEC方案)后再行SLNB及ALND，所有前哨淋巴结(SLN)和腋窝淋巴结均行病理学和免疫组化检查(本研究遵循的程序符合南方医科大学附属深圳市妇幼保健院人体试验委员会制定的伦理学标准，得到该委员会批准)。

结果

SLN检出率、假阴性率、灵敏度、准确性、阴性预测值分别为88.1%，13.3%，80.0%，94.6%，92.6%。新辅助化疗前原发肿瘤直径(≤5 cm与>5 cm)，BMI(<25 kg/m2与≥25 kg/m2)和临床N分期(N1及以下与N2及以上)与化疗后SLN检出率间比较，差异有统计学意义(P<0.05)。

结论

新辅助化疗后SLNB能准确预测腋窝淋巴结状况，化疗前肿瘤直径、临床N分期和BMI是SLN检出率的影响因素。

关键词: 乳腺癌, 新辅助化疗, 前哨淋巴结
Objective

To investigate the feasibility, accuracy and clinical significance of sentinel lymph node biopsy (SLNB) for breast cancer patients after neoadjuvant chemotherapy.

Methods

From June 2010 to June 2012, forty-two breast cancer patients (staging ⅡB were 28 cases, staging ⅢA were 10 cases, staging ⅢB were 4 cases) underwent SLNB by using methylene blue dye as tracer and axillary lymph node dissection (ALND) were retrospectively reviewed. Patients of staging ⅡB and Ⅲ underwent SLNB and ALND after 4-6 circles neoadjuvant chemotherapy. The SLN and ALN specimens were carried out histopathological examination with H&E and immunohistochemstry.

Results

The SLN successful identification rate, false negative rate, sensitivity, accuracy, and negative predictive value was 88.1%, 13.3%, 80.0%, 94.6%, 92.6%, respectively, in breast cancer patients with neoadjuvant chemotherapy. In addition, there had significant differences between SLN identification rate after neoadjuvant chemotherapy and tumour diameter (≤5 cm and >5 cm), BMI (<25 kg/m2 and ≥25 kg/m2), and clinical N stage (N2 stage and N0-1 stage) before neoadjuvant chemotherapy (P<0.05).

Conclusions

The SLNB can accurately predict lymph node status of axillary lymph node in patients with neoadjuvant chemotherapy. Clinical N stage, BMI and tumour diameter are predictors to the identification rate of SLND in the breast cancer patents.

Key words: breast cancer, sentinel lymph node, neoadjuvant chemotherapy
表1 新辅助化疗前患者临床病理学特征与化疗后SLN检出率的关系[n(%)]
Table 1 Relationship between clinicopathological character－istics before neoadjuvant chemotherapy and the identification rates of SLN after neoadjuvant chemotherapy[n(%)]
因素 n 检出率 χ2 P
年龄(岁) ? ? ? ?
? ≤40 28 25(89.3) 0.114 0.736
? >40 14 12(85.7) ? ?
肿瘤直径(cm) ? ? ? ?
? ≤5 29 27(93.1) 4.178 0.041
? >5 13 9(76.9) ? ?
肿块位置 ? ? ? ?
? 外象限 27 24(88.9) 0.045 0.831
? 象限内及中央区 15 13(86.7) ? ?
BMI(kg/m2) ? ? ? ?
? <25 35 33(94.3) 7.674 0.006
? ≥25 7 4(57.1) ? ?
ER ? ? ? ?
? 有转移 26 23(88.5) 0.009 0.926
? 无转移 16 14(87.5) ? ?
PR ? ? ? ?
? 有转移 24 21(87.5) 0.019 0.891
? 无转移 18 16(88.9) ? ?
C－erbB－2 ? ? ? ?
? 有转移 10 9(90.0) 0.045 0.831
? 无转移 32 28(87.5) ? ?
临床N分期 ? ? ? ?
? N1及以下 32 31(96.9) 9.879 0.002
? N2及以上 10 6(60.0) ? ?
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