Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Clin Breast Cancer. 2017 Dec;17(8):644-649. doi: 10.1016/j.clbc.2017.05.002. Epub 2017 May 8.
Sentinel node biopsy (SNB) is used to accurately assess axillary lymph node status in patients with node-negative breast cancer. However, its use after neoadjuvant chemotherapy (NAC) is controversial. We retrospectively assessed the usefulness of SNB after NAC by comparing axillary recurrence rates and other parameters in patients with clinically node-negative breast cancer who underwent SNB after NAC or without NAC.
At our hospital, 1179 patients with clinically node-negative breast cancer underwent SNB from April 2007 to December 2013. The clinicopathological and survival data of patients who underwent SNB after NAC (the NAC group) and those who underwent SNB without NAC (the control group) were compared. Patients with a metastatic sentinel node underwent axillary lymph node dissection.
The number of patients in the NAC and control groups was 183 (15.5%) and 996 (84.5%), respectively. At diagnosis, tumors were significantly larger in the NAC group (P < .0001). Sentinel nodes were identified in almost all patients in both groups (99.5% in the NAC group vs. 99.8% in the control group). They were nonmetastatic in 147 (80.8%) patients in the NAC group and 849 (85.5%) patients in the control group. At the median follow-up time of 51.1 months, 6 patients (0.6%) in the control group had axillary lymph node recurrence compared with no patients in the NAC group.
SNB after NAC was as accurate as SNB without NAC in patients with clinically node-negative breast cancer. Axillary recurrence-free survival rates were excellent regardless of whether NAC was performed before SNB.
前哨淋巴结活检（SNB）用于准确评估淋巴结阴性乳腺癌患者的腋窝淋巴结状态。然而，在新辅助化疗（NAC）后使用 SNB 存在争议。我们通过比较接受 NAC 后 SNB 或不接受 NAC 的临床淋巴结阴性乳腺癌患者的腋窝复发率和其他参数，回顾性评估了 NAC 后 SNB 的有用性。
在我们医院，2007 年 4 月至 2013 年 12 月，1179 例临床淋巴结阴性乳腺癌患者接受了 SNB。比较了接受 NAC 后 SNB（NAC 组）和未接受 NAC 的 SNB（对照组）患者的临床病理和生存数据。有转移性前哨淋巴结的患者行腋窝淋巴结清扫术。
NAC 组和对照组的患者人数分别为 183 例（15.5%）和 996 例（84.5%）。在诊断时，NAC 组的肿瘤明显更大（P <.0001）。两组患者几乎都能识别出前哨淋巴结（NAC 组为 99.5%，对照组为 99.8%）。NAC 组 147 例（80.8%）患者的前哨淋巴结无转移，对照组 849 例（85.5%）患者的前哨淋巴结无转移。在中位随访 51.1 个月时，对照组中有 6 例（0.6%）患者发生腋窝淋巴结复发，而 NAC 组中无患者发生。
在临床淋巴结阴性乳腺癌患者中，NAC 后 SNB 与无 NAC 后 SNB 一样准确。无论是否在 SNB 前进行 NAC，腋窝无复发生存率均优异。
