【作者】 朱伟良；

【导师】 吴浩荣；

【作者基本信息】 苏州大学 ， 普通外科学， 2008， 硕士

【摘要】 目的:研究原发性乳腺癌患者在新辅助化疗(NAC)后进行前哨淋巴结活检(sLNI的可行性和准确性。方法:对60例T1-3N0-2原发性乳腺癌患者先进行NAC 2-4周期,所有患者在NA后腋窝淋巴结临床检查为阴性。用亚甲兰皮下注射法对前哨淋巴结(SLN)进行定位。SLNB后常规实施腋窝淋巴结清扫(ALNC)。术后对所有淋巴结进行常规病理检查。结果:1.新辅助化疗的效果:NAC采用CTF方案35例,TA方案25例。每例应用2-4周期,共应用170周期,平均每例化疗2.8个周期。临床完全缓解(CR)8例(13.3%),临床部分缓解(PR)48例(80.0%),病情稳定(SD)4例(6.7%)。没有疾病进展(PD)和病理完全缓解(pCR)的病例。2.前哨淋巴结活检的结果:60例患者中有55例成功地检出SLN,成功率91.7%(55/60)。每例检出1-4个SLN,平均每例2.6个SLN。55例成功检出SLN的患者中,SLN阳性25例,其中5例(9.1%)仅有SLN阳性。SLN阴性30例。SLN和非前哨淋巴结(NSLN)都为阳性20例,SLN和NSLN都为阴性27例,SLN为阳性而NSLN为阴性5例,SLN为阴性而NSLN为阳性3例。52例SLN的病理学准确预测了腋窝淋巴结(ALN)的病理学状态,准确率94.5%(52/55)。共有3例患者出现了假阴性,即SLN为阴性而NSLN却为阳性,假阴性率10.71%(3/28)。灵敏度89.3%(25/28)。3.SLN的检出率与肿瘤发生的部位,NAC前肿瘤大小,NAC前腋窝淋巴结的状态及NAC的效果均沿有明显的关系。结论:NAC后进行SLNB仍然能够取得较高的检出率和较低的假阴性率,其SLN的病理学状态能够较准确地预测ALN的病理学状态。对于NAC后成功检出SLN的乳腺癌患者,SLNB仍然可以作为取代ALND的一种选择。更多还原

【Abstract】 Objective: To assess the feasibility and accuracy of sentinel lymph node biopsy (SLNB) in breast cancer patients following neoadjuvant chemotherapy (NAG).Methods: A total of 60 consecutive patients with Stage II and III breast cancers,previously treated by NAC, were enrolled in the study. All patients were clinically node-negative after NAC. The patients underwent SLNB,which was mapped with a subdermal injection route over the tumor with methylene blue. This was followed by completion axillary lymph node dissection (ALND). All lymph nodes were examined by routine pathologic examination.Results:1. The outcome of NAC:8 (13.3%) patients achived complete response (CR) ,48 (80.0%) patients achived partial response (PR),4 (6.7%) patients achived stabledisease(SD).There were no PD and pCR patients.2. The outcome of SLNB:SLNB was successful in 55 of 60 patients (detection rate 91.7%). 27 patients (49.1%) had negative nodes on both SLN and non-sentinel lymph node(NSLN), 28 (50.9%) had positive nodes on neither SLN or NSLN. In 5 patients (9.1%),the sentinel node was the only positive node identified. Overall, there was a 94.5%(52/55) concordance between SLN and ALN. There were 3 false negatives in 55 successfully mapped tumors, yielding an FNR of 10.71% (3/28).3. The success rate of sentinel node identification shew no significant difference between the different locations of the tumor,the diffenrent sizes of the tumor befoe NAC,the different axillary lymph node status before NAC and the different clinical response of the tumor afer NAC. Conclusion: Although the SLN identification rate decreased slightly and the false-negative rate increased slightly after neoadjuvant chemotherapy,SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.更多还原