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Received:December 29, 2022 Published Online:November 20, 2023
Received:December 29, 2022 Published Online:November 20, 2023
中文摘要: 目的 探讨影响乳腺癌患者新辅助化疗(NAC)后前哨淋巴结活检(SLNB)准确率的因素,并进行分析。方法 收集十堰市太和医院2020年1月至2022年9月完成乳腺癌NAC并接受SLNB和腋窝淋巴结清扫的患者184例,分析NAC后患者通过纳米炭联合亚甲蓝的双染法进行SLNB的示踪效果,并对影响因素进行logistic回归分析。结果 NAC后行SLNB的检出率为98.9%(182/184),假阴性率为17.5%(14/80),准确率为92.3%(168/182),灵敏度82.5%(66/80),病理完全缓解率为18.5%(34/184)及前哨淋巴结(SLN)转移率为36.3%(66/182);SLNB与腋窝淋巴结清扫后的结果一致性较高(Kappa=0.841,P<0.01);不同的初始腋窝淋巴结临床状态、SLN总数及肿瘤的分子分型在NAC后SLNB的假阴性率差异有统计学意义(P<0.05)。初始腋窝淋巴结的临床状态和肿瘤位置是影响NAC后SLNB准确率的独立因素(P<0.05)。结论 SLNB能够准确地反映初始腋窝淋巴结临床阴性患者的腋窝淋巴结转移状态,而初诊腋窝淋巴结阳性的患者,无论NAC后腋窝淋巴结临床状态是否变为阴性,均不建议行SLNB。
Abstract:Objective To investigate and analyze the factors affecting the accuracy of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods A total of 184 patients with breast cancer who underwent SLNB and axillary lymph node dissection after NAC from January 2020 to September 2022 were collected from Taihe Hospital. The tracer effect of SLNB by carbon nanoparticles combined with methylene blue in patients after NAC was analyzed, and the influencing factors were examined by logistic regression analysis. Results The detection rate of SLNB after NAC was 98.9% (182/184), with a false-negative rate of 17.5% (14/80), accuracy of 92.3% (168/182), sensitivity of 82.5% (66/80), pathological complete response rate of 18.5% (34/184), and sentinel lymph node (SLN) metastasis rate of 36.3% (66/182). The consistency between SLNB and axillary lymph node dissection results was high (Kappa=0.841, P<0.01). The false-negative rate of SLNB after NAC differed significantly in terms of initial axillary lymph node clinical status, total SLN count, and tumor molecular subtype (P<0.05). Initial axillary lymph node clinical status and tumor location were independent factors affecting the accuracy of SLNB after neoadjuvant chemotherapy (P<0.05). Conclusion SLNB may accurately predict axillary lymph node metastasis after NAC in patients with negative axillary lymph node for a preliminary diagnosis. Patients with positive axillary lymph node for a preliminary diagnosis are unsuitable for SLNB whether the clinical status of axillary lymph nodes turns negative or not after NAC.
keywords: Breast cancer Sentinel lymph node biopsy Axillary lymph node dissection Neoadjuvant chemotherapy
文章编号: 中图分类号: 文献标志码:B
基金项目:湖北省教育厅科研计划指导性项目(B2020365);湖北省十堰市太和医院院级科研项目(2022JJXM034)
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