Rebollo-Aguirre A C, Gallego-Peinado M, Menjón-Beltrán S, García-García J, Pastor-Pons E, Chamorro-Santos C E, Ramos-Font C, Salamanca-Ballesteros A, Llamas-Elvira J M, Olea-Serrano N
Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
Rev Esp Med Nucl Imagen Mol. 2012 May-Jun;31(3):117-23. doi: 10.1016/j.remn.2011.04.007. Epub 2011 Jun 14.
To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC).
Between January 2008-2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1-3, N0-1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) were examined by frozen sections, hematoxylin-eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA).
Mean tumor size: 3.5 cm. Histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2.
SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.
评估前哨淋巴结活检（SLNB）在接受新辅助化疗（NAC）的可手术乳腺癌患者中的准确性。
2008年1月至2011年期间，对88例平均年龄49.4岁的浸润性乳腺癌女性患者进行了前瞻性研究。患者为T1-3、N0-1、M0。手术前，患者接受化疗（表柔比星/环磷酰胺、多西他赛），Her2/neu阳性患者接受曲妥珠单抗治疗。通过体格检查、超声引导下对任何可疑淋巴结进行粗针活检来确定腋窝状态。手术前一天，在乳晕周围注射74-111MBq的（99m）Tc-白蛋白纳米胶体。所有患者均接受了乳房手术，包括SLNB，随后进行了完整的腋窝淋巴结清扫（ALND）。前哨淋巴结（SLN）通过冰冻切片、苏木精-伊红染色和免疫组化分析或一步核酸扩增（OSNA）进行检查。
平均肿瘤大小：3.5cm。组织学类型：69例浸润性导管癌，16例浸润性小叶癌，3例其他类型。37例患者初诊时临床/超声检查发现淋巴结阳性。原发性肿瘤对NAC的临床反应：38例完全缓解，45例部分缓解，5例病情稳定。25例达到病理完全缓解。所有患者NAC后临床检查淋巴结均为阴性。SLN识别率为92.0%。7例未找到SLN的患者中，6例在NAC前临床/超声检查腋窝阳性。SLN准确判断腋窝状态的准确率为96.5%。假阴性率为8.3%。69.4%的患者中，SLN是唯一的阳性淋巴结。切除的SLN平均数量为1.7个，从ALND切除的淋巴结数量为13.2个。
NAC后进行SLNB能够在乳腺癌患者中高度准确地预测腋窝状态，避免不必要的ALND。
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