Department of Surgery, Thomas Jefferson University and Hospitals, Philadelphia, PA, USA.
Cancer. 2010 Mar 1;116(5):1243-51. doi: 10.1002/cncr.24887.
The timing and accuracy of axillary sentinel lymph node biopsy (SLNB) in patients who are receiving neoadjuvant chemotherapy (NACT) for breast cancer are controversial. To examine the accuracy of SLNB after NACT, the authors performed SLNB after chemotherapy on all of patients who received NACT at their institution starting in January 1997.
Seventy-nine women who underwent NACT between 1997 and 2008 comprised this study and were divided as follows: 4 women had stage I disease, 60 women had stage II disease, and 15 women had stage III disease, including 10 women who had multicentric disease. Thirty-nine women (49.4%) had clinical evidence of axillary metastasis (N1-N2) at the time of diagnosis. The regimen, the duration of treatment, and the number of cycles of NACT depended on clinical response. The choice of breast conservation therapy or mastectomy was based on the patient's response to treatment and patient preference. All patients underwent SLNB after NACT.
Seventy-three patients underwent breast conservation therapy, and 6 patients underwent mastectomy. Sentinel lymph nodes were identified in 98.7% of patients (in 1 patient, SLNB failed to capture 1 proven axillary metastasis), and 29 patients underwent full axillary lymph node dissection. Fourteen patients (17.7%) had no residual carcinoma (invasive or ductal carcinoma in situ) in their breast, 5 patients (6.3%) had residual ductal carcinoma in situ (only), and 60 patients (75.9%) had residual invasive carcinoma. One false-negative SLNB was reported in the group of 23 patients who underwent full axillary dissection after a negative SLNB. No patient had a subsequent axillary recurrence.
SLNB after NACT was feasible in virtually all patients and accurately selected patients who required complete level I and II axillary dissection. NACT frequently downstaged the axilla, converting patients with N1-N2 lymph node status to N0 status and also avoiding full axillary dissection in these patients.
在接受新辅助化疗（NACT）的乳腺癌患者中，腋窝前哨淋巴结活检（SLNB）的时机和准确性存在争议。为了研究 NACT 后 SLNB 的准确性，作者于 1997 年 1 月开始对在本机构接受 NACT 的所有患者进行了化疗后的 SLNB。
本研究纳入了 1997 年至 2008 年间接受 NACT 的 79 名女性患者，分为以下几类：4 名患者为 I 期疾病，60 名患者为 II 期疾病，15 名患者为 III 期疾病，其中 10 名患者为多中心疾病。39 名女性（49.4%）在诊断时即存在临床腋窝转移（N1-N2）。NACT 的方案、治疗持续时间和周期数取决于临床反应。保乳治疗或乳房切除术的选择基于患者对治疗的反应和患者的偏好。所有患者均在 NACT 后接受 SLNB。
73 名患者接受了保乳治疗，6 名患者接受了乳房切除术。98.7%的患者（1 名患者 SLNB 未能捕获 1 个已证实的腋窝转移）识别出前哨淋巴结，29 名患者接受了完整的腋窝淋巴结清扫。14 名患者（17.7%）乳房内无残留癌（浸润性或导管原位癌），5 名患者（6.3%）仅残留导管原位癌，60 名患者（75.9%）残留浸润性癌。在接受阴性 SLNB 后行完整腋窝清扫的 23 名患者中，报告了 1 例假阴性 SLNB。无患者出现后续腋窝复发。
NACT 后 SLNB 几乎对所有患者均可行，并准确选择了需要进行完整 I 级和 II 级腋窝清扫的患者。NACT 常使腋窝降期，将 N1-N2 淋巴结状态的患者转化为 N0 状态，并避免对这些患者进行完整的腋窝清扫。
