新辅助化疗后前哨淋巴结活检在阳性淋巴结乳腺癌患者中的准确性和局限性。
Accuracy and Limitations of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients with Positive Nodes.
机构信息
Breast Cancer Unit, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, Madrid, Spain.
Research Institute (imas12), Complutense University of Madrid, Madrid, Spain.
出版信息
Breast J. 2022 Aug 5;2022:1507881. doi: 10.1155/2022/1507881. eCollection 2022.
BACKGROUND
Axillary surgical management in patients with node-positive breast cancer at the time of diagnosis converted to negative nodes through neoadjuvant chemotherapy (NAC) remains unclear. Removal of more than two sentinel nodes (SLNs) in these patients may decrease the false negative rate (FNR) of sentinel lymph node biopsies (SLNBs). We aim to analyse the detection rate (DR) and the FNR of SLNB assessment according to the number of SLNs removed.
METHODS
A retrospective study was performed from October 2012 to December 2018. Patients with invasive breast cancer who had a clinically node-positive disease at diagnosis and with a complete axillary response after neoadjuvant chemotherapy were selected. Patients included underwent SLNB and axillary lymph node dissection (ALND) after NAC. The SLN was considered positive if any residual disease was detected. Descriptive statistics were used to describe the clinicopathologic features and the results of SLNB and ALND. The DR of SLNB was defined as the number of patients with successful identification of SLN. Presence of residual disease in ALND and negative SLN was considered false negative.
RESULTS
A total of 368 patients with invasive breast cancer who underwent surgery after complete NAC were studied. Of them, 85 patients met the eligibility criteria and were enrolled in the study. The mean age at diagnosis was 50.8 years. Systematic lymphadenectomy was performed in all patients, with an average of 10 lymph nodes removed. The DR of SLNB was 92.9%, and the FNR was 19.1. The median number of SLNs removed was 3, and at least, three SLNs were obtained in 42 patients (53.2%). When at least three sentinel nodes were removed, the FNR decreased to 8.7%.
CONCLUSIONS
In this cohort, the SLN assessment was associated with an adequate DR and a high FNR. Removing three or more SLNs decreased the FNR from 19.1% to 8.7%. Complementary approaches may be considered for axillary lymph node staging after neoadjuvant chemotherapy. The study was approved by our institution's ethics committee (Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain) (https://clinicaltrials.gov/ct2/show/NCEI:20/0048).
背景
通过新辅助化疗（NAC）将诊断时淋巴结阳性的乳腺癌患者转化为淋巴结阴性，此时腋窝手术管理仍不清楚。在这些患者中，切除超过两个前哨淋巴结（SLNs）可能会降低前哨淋巴结活检（SLNB）的假阴性率（FNR）。我们旨在分析根据切除的 SLN 数量评估 SLNB 的检出率（DR）和 FNR。
方法
对 2012 年 10 月至 2018 年 12 月进行的回顾性研究。选择具有浸润性乳腺癌且诊断时临床淋巴结阳性且新辅助化疗后完全腋窝反应的患者。患者接受 NAC 后进行 SLNB 和腋窝淋巴结清扫术（ALND）。如果检测到任何残留疾病，则认为 SLN 为阳性。使用描述性统计数据描述 SLNB 和 ALND 的临床病理特征和结果。SLNB 的 DR 定义为成功识别 SLN 的患者数量。在 ALND 中存在残留疾病和阴性 SLN 被认为是假阴性。
结果
共研究了 368 例接受完全 NAC 后手术的浸润性乳腺癌患者。其中，85 例符合纳入标准并纳入研究。诊断时的平均年龄为 50.8 岁。所有患者均进行系统淋巴结清扫术，平均切除 10 个淋巴结。SLNB 的 DR 为 92.9%，FNR 为 19.1%。切除的 SLN 中位数为 3 个，至少有 42 例患者（53.2%）获得 3 个以上 SLN。当切除至少 3 个 SLN 时，FNR 降低至 8.7%。
结论
在该队列中，SLN 评估与足够的 DR 和高 FNR 相关。切除 3 个或更多 SLN 可将 FNR 从 19.1%降低至 8.7%。在新辅助化疗后，可能需要考虑补充方法进行腋窝淋巴结分期。该研究得到了我们机构伦理委员会的批准（马德里Complutense 大学 12 月 12 日研究所（imas12），马德里，西班牙）（https://clinicaltrials.gov/ct2/show/NCEI:20/0048）。
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