Hino Masato, Sano Muneaki, Sato Nobuaki, Homma Keiichi
Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
Surg Today. 2008;38(7):585-91. doi: 10.1007/s00595-007-3686-2. Epub 2008 Jul 9.
This study was undertaken to assess the feasibility of performing a sentinel lymph node biopsy (SLNB) for a patient with operable breast cancer after undergoing neoadjuvant chemotherapy (NAC).
Between January 2002 and December 2003, women with primary breast cancer who had a breast tumor measuring larger than 3 cm in unilateral diameter were eligible for NAC. All patients who had completed NAC underwent lymphatic mapping with labeled (99m)Tc phytate on the day before surgery. Sentinel lymph node biopsy followed by a full axillary lymph node (AXLN) dissection (ALND) was performed in all patients. Sentinel lymph nodes (SLN) were sent for a frozen-section examination.
The rate of SLN identification was 71%. Both the sensitivity and negative predictive value of SLNB were 100%. The false negative rate was 0%. When candidates for SLNB were restricted to patients with a breast tumor measuring less than 3 cm and clinically negative nodes after NAC, the rate of SLN identification increased to 93% from 71% while still maintaining the 0% false negative rate.
Sentinel lymph node biopsy after NAC is therefore considered to be a feasible and accurate method to predict the AXLN status in patients who have a breast tumor measuring less than 3 cm in unilateral diameter and a clinically negative AXLN status at the time of surgery after NAC.
本研究旨在评估对接受新辅助化疗（NAC）后可手术的乳腺癌患者进行前哨淋巴结活检（SLNB）的可行性。
2002年1月至2003年12月期间，单侧直径大于3 cm的原发性乳腺癌女性患者符合NAC条件。所有完成NAC的患者在手术前一天接受用标记的（99m）锝植酸盐进行的淋巴绘图。所有患者均进行前哨淋巴结活检，随后进行全腋窝淋巴结（AXLN）清扫（ALND）。前哨淋巴结（SLN）送去做冰冻切片检查。
SLN识别率为71%。SLNB的敏感性和阴性预测值均为100%。假阴性率为0%。当SLNB的候选者仅限于NAC后乳腺肿瘤小于3 cm且临床淋巴结阴性的患者时，SLN识别率从71%提高到93%，同时仍保持0%的假阴性率。
因此，NAC后的前哨淋巴结活检被认为是一种可行且准确的方法，可用于预测单侧直径小于3 cm且NAC后手术时临床AXLN阴性的乳腺癌患者的AXLN状态。
