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目的分析乳腺癌经肋间隙内乳淋巴结切除活检在乳腺癌分期与辅助治疗中的价值。方法回顾性分析济南军区总医院甲状腺乳腺外科2003年5月至2014年1月期间305例(根据是否行新辅助化疗分为新辅助化疗组和无新辅助化疗组)行乳腺癌各式改良根治术与经肋间隙内乳淋巴结切除活检患者的相关临床与病理资料,包括患者年龄、腋窝淋巴结、内乳淋巴结转移状况等信息,分析内乳淋巴结对乳腺癌分期与治疗的影响。结果新辅助化疗组共收集乳腺癌患者67例,发生腋窝淋巴结转移者45例(67.2%),内乳淋巴结转移者23例(34.3%);乳腺癌淋巴结病理(pN)分期改变者23例(34.3%),乳腺癌肿瘤病理(pTNM)分期改变者8例(11.9%)。无新辅助化疗组共收集乳腺癌患者238例,发生腋窝淋巴结转移者155例(65.1%),内乳淋巴结转移者30例(12.6%);乳腺癌pN分期改变者30例(12.6%),pTNM分期改变者23例(9.66%)。新辅助化疗组的内乳淋巴结转移率明显高于无新辅助化疗组(χ2=15.7,P<0.05),pTNM分期改变率也明显高于无新辅助化疗组(χ2=5.3,P<0.05)。结论经肋间隙内乳淋巴结活检对乳腺癌pN分期、pTNM分期有一定的影响。新辅助化疗不能使所有内乳淋巴结转移癌达到病理完全缓解。经肋间隙内乳淋巴结活检不仅可完善乳腺癌pN和pTNM分期,而且能够指导乳腺癌术后辅助治疗,减少内乳区局部过度治疗,有助于乳腺癌患者个体化治疗。
Objective To analyze the value of breast cancer biopsy in the staging and adjuvant treatment of breast cancer through intercostal space. Methods A retrospective analysis of 305 cases of thyroid gland thyroid surgery in General Hospital of Jinan Military Region between May 2003 and January 2014 (according to whether neoadjuvant chemotherapy was divided into neoadjuvant chemotherapy group and no neoadjuvant chemotherapy group) underwent various radical mastectomy of breast cancer To analyze the clinical and pathological data of patients with breast lymph node dissection and biopsy through the intercostal space, including the age of patients, axillary lymph nodes and the status of internal mammary lymph node metastasis, and to analyze the effect of internal mammary lymph nodes on the staging and treatment of breast cancer. Results In the neoadjuvant chemotherapy group, 67 cases of breast cancer were collected, 45 cases (67.2%) had axillary lymph node metastasis, 23 cases (34.3%) had internal mammary lymph node metastasis, 23 cases had breast cancer with pathological changes of lymph node (pN) 34.3%), and 8 cases (11.9%) of staging of breast cancer neoplasm (pTNM). No neoadjuvant chemotherapy was collected in 238 cases of breast cancer patients, 155 cases (65.1%) of axillary lymph node metastases, 30 cases of internal mammary lymph node metastasis (12.6%); 30 cases of breast cancer (pN stage changes were 12.6% Twenty-three patients with pTNM staging changed (9.66%). Neoadjuvant chemotherapy group was significantly higher than the rate of internal mammary lymph node metastasis without neoadjuvant chemotherapy (χ2 = 15.7, P <0.05), pTNM staging changes were significantly higher than those without neoadjuvant chemotherapy (χ2 = 5.3, P <0.05) . Conclusion Breast lymph node biopsy in the intercostal space has some influence on pN stage and pTNM stage of breast cancer. Neoadjuvant chemotherapy can not achieve complete pathological remission in all intra-breast lymph node metastases. Breast lymph node biopsy through the intercostal space can not only improve breast cancer pN and pTNM staging, but also to guide the postoperative adjuvant treatment of breast cancer, reduce the local breast over-treatment, contribute to the individualized treatment of breast cancer patients.