CAJ | 학술논문

目的探讨新辅助化疗后腋窝降期为临床阴性乳腺癌患者前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的可行性和准确性.方法对新辅助化疗前均经细针穿刺细胞学证实腋窝淋巴结阳性,新辅助化疗后腋窝淋巴结转阴的147例乳腺癌,先行SLNB再行腋窝淋巴结清扫术(axillary lymph node dissection,ALND),并比较.结果 147例SLNB与ALND的成功率、假阴性率、准确率分别为87.07％(128/147)、14.43％ (14/97)、89.06％ (114/128),其中14.84％(19/128)的患者SLN为腋窝惟一阳性淋巴结.腋淋巴结转阴率24.50％ (36/147),完成新辅助化疗占化疗总周期数80％以上患者腋窝淋巴结转阴率40.54％(15/37),高于不足80％患者的19.09％ (21/110),差异有统计学意义(P=0.009),且SLNB成功率和准确性均提高.新辅助化疗前初始腋窝cN1期患者与cN2 ～3期患者比较,其SLNB的假阴性率(6.82％ vs24.44％,P=0.016)和准确率(95.31％ vs 82.81％,P=0.023)差异有统计学意义,而新辅助化疗前初始乳腺原发肿瘤大小及新辅助化疗后乳腺原发肿瘤降期对SLNB成功率和准确性均无显著影响.联合法SLNB的成功率、假阴性率及准确性均优于单纯蓝染料法.结论新辅助化疗后腋窝淋巴结转阴患者SLNB技术上可行,准确性可接受；新辅助化疗后通过SLNB进行腋窝分期,可望使患者在新辅助化疗中获益最大化.
목적 탐토신보조화료후액와강기위림상음성유선암환자전초림파결활검(sentinel lymph node biopsy,SLNB)적가행성화준학성.방법 대신보조화료전균경세침천자세포학증실액와림파결양성,신보조화료후액와림파결전음적147례유선암,선행SLNB재행액와림파결청소술(axillary lymph node dissection,ALND),병비교.결과 147례SLNB여ALND적성공솔、가음성솔、준학솔분별위87.07％(128/147)、14.43％ (14/97)、89.06％ (114/128),기중14.84％(19/128)적환자SLN위액와유일양성림파결.액림파결전음솔24.50％ (36/147),완성신보조화료점화료총주기수80％이상환자액와림파결전음솔40.54％(15/37),고우불족80％환자적19.09％ (21/110),차이유통계학의의(P=0.009),차SLNB성공솔화준학성균제고.신보조화료전초시액와cN1기환자여cN2 ～3기환자비교,기SLNB적가음성솔(6.82％ vs24.44％,P=0.016)화준학솔(95.31％ vs 82.81％,P=0.023)차이유통계학의의,이신보조화료전초시유선원발종류대소급신보조화료후유선원발종류강기대SLNB성공솔화준학성균무현저영향.연합법SLNB적성공솔、가음성솔급준학성균우우단순람염료법.결론 신보조화료후액와림파결전음환자SLNB기술상가행,준학성가접수；신보조화료후통과SLNB진행액와분기,가망사환자재신보조화료중획익최대화.
Objective To evaluate the feasibility and accuracy of sentinel lymph node biopsy(SLNB) in previous axillary node positive breast cancer patients whose axillary nodes turned negative after neoadjuvant chemotherapy(NAC).Methods 147 consecutive breast cancer patients with clinically node-negative after NAC were retrospectively analyzed.These patients underwent SLNB followed by complete axillary lymph node dissection.All patients were proved to be axillary node-positive by fine needle aspiration cytology before NAC.Results The identification rate,false negative rate and accuracy for SLNB was 87.07％ (128/147),14.43％ (14/97)and 89.06％ (114/128)respectively.SLNs were the only positive nodes in 14.84％ patients(19/128).The rate of pathologically negative axillary lymph node was 24.50％ (36/147),significantly higher in patients who received NAC more than 80％ of the total cycles than in those who received NAC less than 80％ of the total cycles (40.54％ vs 19.09％,P =0.009),and was accompanied with improved identification rate and accuracy of SLNB.The difference of false negative rate (6.82％ vs 24.44％,P =0.016) and accuracy (95.31％ vs 82.81％,P =0.023) had statistical significance between patients initially in axillary cN1 and in cN2 ～ 3,while no connection was found with the initial size and down-stage of the primary tumor.The identification rate,false negative rate and accuracy were improved in patients with combined Methylene blue and99m Tc-SC than in patients with Methylene blue alone.Conclusions It is technically feasible to perform SLNB in clinically negative-node barest cancer patients after NAC,and the SLNB accuracy remains reasonable.It is possible to maximize the benefits of NAC by using SLNB to stage the axillary lymph nodes in patients who are node-negative after NAC.