Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Pathology, Seoul National University Hospital, Seoul, Korea.
J Breast Cancer. 2013 Dec;16(4):378-85. doi: 10.4048/jbc.2013.16.4.378. Epub 2013 Dec 31.
Sentinel lymph node biopsy (SLNB) is an accurate and effective means of axillary nodal staging in early breast cancer. However its indication after neoadjuvant chemotherapy (NAC) is under constant debate. The present study evaluates the reliability of SLNB in assessing axillary nodal status after NAC.
Data from 281 patients who had received NAC and subsequent SLNB were reviewed. The identification and false negative rates of SLNB were determined and the clinicopathologic factors associated with false negative results were investigated using univariate analysis.
The identification rate of SLNB after NAC was 93.6% and the false negative rate was 10.4%. Hormone receptor status, especially progesterone receptor positivity, was significantly associated with false negative results. The accuracy of intraoperative frozen section examination of sentinel lymph nodes was 91.2%.
The identification rate of SLNB and the accuracy of intraoperative frozen section examination after NAC are comparable to the results without NAC in patients with early breast cancer. However considering the high false negative rates, general application of SLNB after NAC should be avoided. Patients with progesterone-positive tumors and non-triple-negative breast cancers may be a select group of patients in whom SLNB can be employed safely after NAC, but further studies are necessary.
前哨淋巴结活检（SLNB）是早期乳腺癌腋窝淋巴结分期的一种准确、有效的方法。然而，新辅助化疗（NAC）后其适应证仍存在争议。本研究旨在评估 SLNB 在评估 NAC 后腋窝淋巴结状态方面的可靠性。
回顾性分析了 281 例接受 NAC 及随后 SLNB 的患者资料。确定 SLNB 的检出率和假阴性率，并采用单因素分析方法探讨与假阴性结果相关的临床病理因素。
NAC 后 SLNB 的检出率为 93.6%，假阴性率为 10.4%。激素受体状态，特别是孕激素受体阳性，与假阴性结果显著相关。术中冰冻切片检查哨兵淋巴结的准确率为 91.2%。
NAC 后 SLNB 的检出率和术中冰冻切片检查的准确率与未接受 NAC 的早期乳腺癌患者相似。然而，考虑到假阴性率较高，应避免常规应用 NAC 后的 SLNB。孕激素阳性肿瘤和非三阴性乳腺癌患者可能是一组可以安全应用 NAC 后 SLNB 的患者，但仍需要进一步研究。
