Han Chao, Yang Ben, Zuo Wen-Shu, Liu Yan-Song, Zheng Gang, Yang Li, Zheng Mei-Zhu
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250022, Shandong, P.R. China.
Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China.
Chin J Cancer. 2016 Apr 4;35:35. doi: 10.1186/s40880-016-0099-x.
Although sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false-negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node (PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of "skip metastasis" on the FNR of SLNB.
At Shandong Cancer Hospital Affiliated to Shandong University between March 1, 2012 and June 30, 2015, the sentinel lymph nodes (SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer. First, the SLNs were removed; then, the area surrounding the original SLNs was selected, and the visible lymph nodes in a field of 3-5 cm in diameter around the center (i.e., PLNs) were removed, avoiding damage to the structure of the breast. Finally, ALND was performed. The SLNs, PLNs, and remaining ALNs underwent pathologic examination, and the relationship between them was analyzed.
The identification rate of SLNs in the 596 patients was 95.1% (567/596); the metastasis rate of ALNs was 33.7% (191/567); the FNR of pure SLNB was 9.9% (19/191); and after the SLNs and PLNs were eliminated, the FNR was 4.2% (8/191), which was significantly decreased compared with the FNR before removal of PLNs (P = 0.028). According to the detected number (N) of SLNs, the patients were divided into four groups of N = 1, 2, 3, and ≥4; the FNR in these groups was 19.6, 9.8, 7.3, and 2.3%, respectively. For the patients with ≤2 or ≤3 detected SLNs, the FNR after removal of PLNs was significantly decreased compared with that before removal of PLNs (N ≤ 2: 14.0% vs. 4.7%, P = 0.019; N ≤ 3: 12.2% vs. 4.7%, P = 0.021), whereas for patients with ≥4 detected SLNs, the decrease in FNR was not statistically significant (P = 1.000). In the entire cohorts, the "skip metastasis" rate was 2.5% (15/596); the FNR caused by "skip metastasis" was 2.1% (4/191).
The FNR of SLNB was associated with the number of SLNs. For patients with ≤3 detected SLNs, PLN sampling can reduce the FNR of SLNB to an acceptable level of less than 5%. Because of the existence of the "skip metastasis" and distinct metastasis patterns, the FNR of SLNB cannot be completely eliminated.
尽管前哨淋巴结活检（SLNB）能够准确预测腋窝淋巴结（ALN）转移状态，但SLNB较高的假阴性率（FNR）仍是接受SLNB而非腋窝淋巴结清扫术（ALND）患者治疗的主要障碍。本研究旨在评估SLNB联合外周淋巴结（PLN）采样对降低乳腺癌FNR的临床意义，并探讨“跳跃转移”对SLNB的FNR的影响。
2012年3月1日至2015年6月30日期间，在山东大学附属山东省肿瘤医院，对596例乳腺癌患者采用放射性胶体联合蓝色染料示踪剂检测前哨淋巴结（SLN）。首先，切除SLN；然后，选择原SLN周围区域，切除以中心为圆心、直径3 - 5 cm范围内可见的淋巴结（即PLN），同时避免损伤乳房结构。最后，进行ALND。对SLN、PLN和剩余的ALN进行病理检查，并分析它们之间的关系。
596例患者中SLN的检出率为95.1%（567/596）；ALN转移率为33.7%（191/567）；单纯SLNB的FNR为9.9%（19/191）；在切除SLN和PLN后，FNR为4.2%（8/191），与切除PLN前的FNR相比显著降低（P = 0.028）。根据检测到的SLN数量（N），将患者分为N = 1、2、3和≥4四组；这些组的FNR分别为19.6%、9.8%、7.3%和2.3%。对于检测到的SLN≤2个或≤3个的患者，切除PLN后的FNR与切除PLN前相比显著降低（N≤2：14.0%对4.7%，P = 0.019；N≤3：12.2%对4.7%，P = 0.021），而对于检测到的SLN≥4个的患者，FNR的降低无统计学意义（P = 1.000）。在整个队列中，“跳跃转移”率为2.5%（15/596）；由“跳跃转移”导致的FNR为2.1%（4/191）。
SLNB的FNR与SLN数量有关。对于检测到的SLN≤3个的患者，PLN采样可将SLNB的FNR降低至可接受的低于5%的水平。由于“跳跃转移”的存在和不同的转移模式，SLNB的FNR无法完全消除。
