Kinoshita Takayuki, Takasugi Miyuki, Iwamoto Eriko, Akashi-Tanaka Sadako, Fukutomi Takashi, Terui Shoji
Division of Surgical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji Chuo-ku, Tokyo 104-0045, Japan.
Am J Surg. 2006 Feb;191(2):225-9. doi: 10.1016/j.amjsurg.2005.06.049.
The feasibility and accuracy of sentinel lymph node (SLN) biopsy examination for breast cancer patients with clinically node-negative breast cancer after neoadjuvant chemotherapy (NAC) have been investigated under the administration of a radiocolloid imaging agent injected intradermally over a tumor. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical nodal status before NAC were analyzed.
Seventy-seven patients with stages II and III breast cancer previously treated with NAC were enrolled in the study. All patients were clinically node negative after NAC. The patients then underwent SLN biopsy examination, which involved a combination of intradermal injection over the tumor of radiocolloid and a subareolar injection of blue dye. This was followed by standard level I/II axillary lymph node dissection.
The SLN could be identified in 72 of 77 patients (identification rate, 93.5%). In 69 of 72 patients (95.8%) the SLN accurately predicted the axillary status. Three patients had a false-negative SLN biopsy examination result, resulting in a false-negative rate of 11.1% (3 of 27). The SLN identification rate tended to be higher, although not statistically significantly, among patients who had clinically negative axillary lymph nodes before NAC (97.6%; 41 of 42). This is in comparison with patients who had a positive axillary lymph node before NAC (88.6%; 31 of 35).
The SLN identification rate and false-negative rate were similar to those in nonneoadjuvant studies. The SLN biopsy examination accurately predicted metastatic disease in the axilla of patients with tumor response after NAC and clinical nodal status before NAC. This diagnostic technique, using an intradermal injection of radiocolloid, may provide treatment guidance for patients after NAC.
在对肿瘤进行皮内注射放射性胶体显像剂的情况下，已对新辅助化疗（NAC）后临床腋窝淋巴结阴性的乳腺癌患者进行前哨淋巴结（SLN）活检检查的可行性和准确性展开研究。此外，还分析了可能影响SLN活检检测以及与NAC前临床肿瘤反应和临床腋窝淋巴结状态相关的假阴性率的情况。
77例曾接受NAC治疗的II期和III期乳腺癌患者纳入本研究。所有患者在NAC后临床腋窝淋巴结均为阴性。这些患者随后接受了SLN活检检查，该检查包括在肿瘤上进行放射性胶体皮内注射以及乳晕下注射蓝色染料。之后进行标准的I/II级腋窝淋巴结清扫术。
77例患者中有72例（识别率为93.5%）可识别出SLN。72例患者中有69例（95.8%）的SLN准确预测了腋窝状态。3例患者SLN活检检查结果为假阴性，假阴性率为11.1%（27例中的3例）。在NAC前临床腋窝淋巴结为阴性的患者中，SLN识别率虽无统计学显著差异，但有更高的趋势（97.6%；42例中的41例）。相比之下，NAC前腋窝淋巴结为阳性的患者SLN识别率为88.6%（35例中的31例）。
SLN识别率和假阴性率与非新辅助研究中的相似。SLN活检检查准确预测了NAC后有肿瘤反应且NAC前临床腋窝淋巴结状态的患者腋窝中的转移疾病。这种采用放射性胶体皮内注射的诊断技术可能为NAC后的患者提供治疗指导。
