Zhang Juliang, Wang Ting, Yan Changjiao, Huang Meiling, Fan Zhimin, Ling Rui
Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, People's Republic of China.
Department of Breast Surgery, The First Affiliated Hospital of Jilin University, Changchun, Jilin 130021, People's Republic of China.
Clin Epidemiol. 2020 Sep 1;12:917-924. doi: 10.2147/CLEP.S264349. eCollection 2020.
Sentinel lymph node biopsy (SLNB) was introduced over 30 years ago, but the application of SLNB in China is unclear. This study aimed to explore the real-world implementation of SLNB among early-stage breast cancer patients in China.
A multi-center, retrospective study was conducted among primary breast cancer patients from 37 hospitals in China in 2018. Their clinical data were collected and analyzed, including the implementation status of SLNB in China, subsequent processing of sentinel lymph nodes (SLNs) containing metastases, and the effect of neoadjuvant chemotherapy (NAC) on SLNB.
SLNB surgery was performed on 43.5% of early-stage breast cancer patients in China and 11,942 patients who underwent SLNB were enrolled in this study. The majority of SLNBs were performed using a single mapping agent. A combination of blue dye and radiotracer or fluorescence imaging was used in only 14.9% of patients. The mean (SD) number of resected SLNs was 4.0 (2.1). For the patients with 1 or 2 positive SLNs, 83.0% of them continued to receive axillary lymph node dissection (ALND), while others did not. For the patients with three or more positive SLNs, 97.2% of them continued to receive ALND, among which 82.9% accepted radiotherapy simultaneously. Of the patients who underwent SLN surgery, 5.5% (654/11,942) were receiving NAC. Among them, 51.9% received SLNB before NAC, and the rest received SLNB after NAC. In biopsy-proven positive nodes, 64.7% positive SLNs turned negative after NAC.
SLNB has been promoted in China, but it is not widely used compared to in developed countries. Furthermore, the usage of the dual tracer technique in SLNB is not high. Chinese breast surgeons are more conservative regarding the omission of ALND in 1 or 2 SLNs-positive patients.
前哨淋巴结活检（SLNB）在30多年前就已被引入，但在中国的应用情况尚不清楚。本研究旨在探讨中国早期乳腺癌患者中SLNB的实际应用情况。
2018年对中国37家医院的原发性乳腺癌患者进行了一项多中心回顾性研究。收集并分析了他们的临床数据，包括中国SLNB的实施情况、对含有转移灶的前哨淋巴结（SLN）的后续处理以及新辅助化疗（NAC）对SLNB的影响。
中国43.5%的早期乳腺癌患者接受了SLNB手术，本研究纳入了11942例接受SLNB的患者。大多数SLNB手术仅使用一种示踪剂。仅14.9%的患者使用了蓝色染料和放射性示踪剂或荧光成像相结合的方法。切除的SLN平均（标准差）数量为4.0（2.1）个。对于1个或2个SLN阳性的患者，83.0%的患者继续接受腋窝淋巴结清扫（ALND），而其他患者则未接受。对于3个或更多SLN阳性的患者，97.2%的患者继续接受ALND，其中82.9%的患者同时接受了放疗。在接受SLN手术的患者中，5.5%（654/11942）正在接受NAC。其中，51.9%的患者在NAC前接受了SLNB，其余患者在NAC后接受了SLNB。在活检证实为阳性的淋巴结中，64.7%的阳性SLN在NAC后转为阴性。
SLNB在中国已得到推广，但与发达国家相比，其应用并不广泛。此外，SLNB中双示踪技术的使用率不高。中国乳腺外科医生对于1个或2个SLN阳性患者省略ALND更为保守。
