摘要
目的探讨乳腺癌化疗后前哨淋巴结活检术(SLNB)的准确性及临床意义。方法用美蓝作为示踪剂,对90例临床分期为Ⅱ、Ⅲ期,并已行化疗后临床检查腋窝淋巴结阴性的乳腺癌患者进行SLNB,术中均同时行腋窝淋巴结清扫术。结果90例中前哨淋巴结成功检出82例,检出率91.1%,每例检出前哨淋巴结的数量为1～4枚,平均1.6枚。82例前哨淋巴结成功检出的患者中,45例患者有腋窝淋巴结转移,其中前哨淋巴结有转移者40例,前哨淋巴结未发现转移而非前哨淋巴结有转移者5例,8例只有前哨淋巴结为阳性淋巴结,前哨淋巴结预测腋窝淋巴结状态准确率为93.9%(77/82),灵敏度为88.9%(40/45),阳性预测值为100%,阴性预测值为88.1%,假阴性率为11.1%(5/45)。原发肿瘤为T2、T3/T4组检出率分别为96.1% (49/51)、84.6%(33/39);假阴性率分别为5.3%(1/19)、15.4%(4/26),差异无统计学意义。肿瘤对化疗反应为完全缓解(CR)、部分缓解(PR)、稳定(SD)的前哨淋巴结检出率分别为92.3%、93。1%、84.2%,差异无统计学意义;假阴性5例均发生在PR、SD患者。结论化疗后腋窝淋巴结阴性的Ⅱ、Ⅲ期乳腺癌患者,行SLNB可获得与早期未行新辅助化疗乳腺癌SLNB相似的结果;化疗前原发肿瘤为T2的乳腺癌患者,SLNB能较准确预测腋窝淋巴结的状态。
Objective To study the accuracy and the clinical significance of sentinel lymph node biopsy （SLNB） after neoadjuvant chemotherapy for breast cancer. Methods A total of 90 patients with Stage Ⅱ or Ⅲ breast cancer and negative axillary node after neoadjuvant chemotherapy were enrolled in the study. Mapping procedure and SLNB were performed using methylene blue injected at the site of the primary breast cancer, followed by the axillary lymph node dissection. Results The sentinel lymph node（SLN） was successfully identified in 82 out of 90 patients.（91.1% ）. The number of sentinel harvested nodes ranged from 1 to 4（average 1.6）. The accuracy of SLNB to predict the axillary lymph node status was 93.9 % （77/82）,the sensitivity, positive predictive value,negative predictive value and false negative rate were 87.5 % （40/45）, 100 % , 88.1% and 11.1% （5/45 ）, respectively, The SLN identification rate tended to be higher and false negative rate tended to be lower in patients with T2 primary tumor before neoadjuvant chemotherapy. Conclusion Our study indicated that SLNB after neoadjuvant chemotherapy in patients with Stage Ⅱ or Ⅲ breast cancer had a similar effect as SLNB in non-neoadjuvant studies. SLNB was considered to be able to accurately predict the axillary lymph node status in patients with T2 primary tumor before neoadjuvant chemotherapy.
出处
《中国基层医药》
CAS
2007年第10期1636-1637,共2页
Chinese Journal of Primary Medicine and Pharmacy
关键词
乳腺肿瘤
药物疗法
淋巴结
Breast neoplasms
Drug therapy
Sentinel lymph node biopsy
