Péley Gábor, Török Klára, Farkas Emil, Mátrai Zoltán, Horváth Zsolt, Sinkovics István, Hitre Erika, Rényi-Vámos Ferenc, Orosz Zsolt, Köves István
Országos Onkológiai Intézet, Budapest 1122, Hungary.
Magy Onkol. 2006;50(1):19-23. Epub 2006 Apr 17.
The feasibility, accuracy and clinical significance of sentinel lymph node biopsy for patients with breast cancer after neoadjuvant chemotherapy has not yet been determined. The aim of this study was to investigate these questions.
Dual agent-guided sentinel lymph node biopsy with preoperative lymphoscintigraphy was performed on 17 breast cancer patients after neoadjuvant chemotherapy at the Department of General and Thoracic Surgery, National Institute of Oncology, Budapest, from April 2004 to August 2005. Patients with clinically lymph node-negative breast cancer less than 3 cm in size after neoadjuvant chemotherapy were enrolled in the study.
Lymphoscintigraphy showed no axillary lymphatic drainage in 7 patients (41%), and no sentinel lymph node could be identified during surgery in these patients. Axillary lymph nodes were histologically positive in 6 (86%) out of these 7 patients. Sentinel lymph node biopsy was successful in 10 patients (59%), and in 8 (80%) of them the sentinel lymph node proved to be positive pathologically. False negative sentinel lymph node biopsy did not occur. Axillary lymph node status was histologically positive in 14 (82%) out of the 17 patients. The predictable value of the clinical examination of the axilla after neoadjuvant chemotherapy, for the histological nodal status, was very low.
Our sentinel lymph node identification rate is lower than the published average in the literature. This difference can be explained by the differences in the indication for neoadjuvant chemotherapy. Our false negative rate (0%) is, however, significantly better than that of others. On the basis of international experiences sentinel lymph node biopsy after neoadjuvant chemotherapy is technically feasible, but its accuracy is not satisfactory and its clinical significance has not yet been determined. Our success rate is specifically low, which cannot be explained by the lack of practice. Taking the histologically very high axillary positive rate into consideration, sentinel lymph node biopsy has no clinical role in our practice after neoadjuvant chemotherapy.
新辅助化疗后乳腺癌患者前哨淋巴结活检的可行性、准确性及临床意义尚未确定。本研究旨在探讨这些问题。
2004年4月至2005年8月期间，在布达佩斯国家肿瘤研究所普通胸外科，对17例新辅助化疗后的乳腺癌患者进行了术前淋巴闪烁显像引导下的双药引导前哨淋巴结活检。纳入研究的患者为新辅助化疗后临床腋窝淋巴结阴性且肿瘤大小小于3 cm的乳腺癌患者。
淋巴闪烁显像显示7例患者（41%）腋窝无淋巴引流，手术中这些患者未发现前哨淋巴结。这7例患者中有6例（86%）腋窝淋巴结组织学检查呈阳性。10例患者（59%）前哨淋巴结活检成功，其中8例（80%）前哨淋巴结病理检查呈阳性。未出现前哨淋巴结活检假阴性情况。17例患者中有14例（82%）腋窝淋巴结组织学检查呈阳性。新辅助化疗后腋窝临床检查对组织学淋巴结状态的预测价值非常低。
我们的前哨淋巴结识别率低于文献报道的平均水平。这种差异可通过新辅助化疗适应证的不同来解释。然而，我们的假阴性率（0%）明显优于其他研究。基于国际经验，新辅助化疗后前哨淋巴结活检在技术上是可行的，但其准确性并不令人满意，临床意义尚未确定。我们的成功率特别低，这不能用缺乏实践来解释。考虑到腋窝组织学阳性率非常高，新辅助化疗后前哨淋巴结活检在我们的实践中没有临床作用。
