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目的:探讨乳腺癌新辅助化疗后行染料法前哨淋巴结活检的可行性、有效性及准确性。方法:对2007年5月至2011年4月期间41例广州医学院第一附属医院乳腺外科确诊为乳腺癌的患者(Ⅱ期或Ⅲ期)予2～4个疗程新辅助化疗后,行患侧亚甲蓝示踪前哨淋巴结活检+乳腺癌改良根治术或联合腋窝淋巴结(Ⅰ-Ⅱ/Ⅲ级)清扫的乳腺癌保乳术。结果:在Ⅰ级腋窝淋巴结中检出前哨淋巴结39例,每例平均前哨淋巴结及腋窝淋巴结的检出数目分别为1.5±0.2枚和17±5枚。前哨淋巴结的检出率、准确率、灵敏度,假阴性率分别为95.1%、92.3%、88.0%、12.0%,以上各指标与新辅助化疗前患者的原发肿瘤大小、区域淋巴结分级、TNM分期、年龄,或者体重指数之间无相关性(P>0.05)。结论:对于部分行新辅助化疗后的乳腺癌患者,亚甲蓝示踪前哨淋巴结活检是安全可行的,且能较准确预测腋窝淋巴结的状况。
Objective: To investigate the feasibility, validity and accuracy of sentinel lymph node biopsy by dye method after neoadjuvant chemotherapy in breast cancer. Methods: From May 2007 to April 2011, 41 patients with breast cancer diagnosed as Breast cancer from the First Affiliated Hospital of Guangzhou Medical College (stage Ⅱ or Ⅲ) were treated with neoadjuvant chemotherapy for 2-4 cycles. Side methylene blue tracer sentinel lymph node biopsy + modified radical mastectomy or combined axillary lymph node (Ⅰ-Ⅱ / Ⅲ grade) breast conserving surgery. Results: Sentinel lymph nodes were detected in grade Ⅰ axillary lymph nodes. The average number of sentinel lymph nodes and axillary lymph nodes in each case was 1.5 ± 0.2 and 17 ± 5, respectively. The detection rate, accuracy, sensitivity and false negative rate of sentinel lymph node were 95.1%, 92.3%, 88.0% and 12.0% respectively. The above indexes were correlated with the primary tumor size, regional lymph node grade, TNM stage , Age, or body mass index (P> 0.05). CONCLUSIONS: Methylene blue tracer sentinel lymph node biopsy is safe and feasible for some patients with breast cancer after neoadjuvant chemotherapy and can accurately predict the status of axillary lymph nodes.