关键词: 乳腺癌, 前哨淋巴结活检, 问卷调查

Abstract: Background and purpose: Sentinel lymph node biopsy (SLNB) has become the standard axillary staging procedure for clinically nodal-negative (cN ₀ ) breast cancer patients. This study was sponsored by the Chinese Anti-Cancer Association, Committee of Breast Cancer Society and aimed to explore the current clinical practice of SLNB in large hospitals in China. Methods: A total of 110 hospitals with more than 200 breast cancer operations in 2017 were included, and finally a total of 110 hospitals completed the questionnaire survey. The questionnaire included the current status of SLNB, the acceptance of omitting axillary lymph node dissection (ALND) and the use of SLNB in neoadjuvant chemotherapy (NAC). Data were analyzed using χ ² test, Fisher’s exact test or Kolmogorov-Smirnov test. Results: All the hospitals included in the study performed SLNB. A total of 85 (77.27%) hospitals routinely performed SLNB for more than 50% of patients with clinically axillary node-negative breast cancer. The proportion of SLNB in cancer centers (χ ² =5.62, P=0.018) and hospitals with more breast-conserving surgery (BCS) performed (D=0.33, P=0.032) was higher. Internal mammary sentinel lymph node biopsy (IM-SLNB) was not available in most of the hospitals (93/110, 84.55%). As for the choice of mapping agent, most of the hospitals (69/110, 62.7%) used methylene blue alone, while 14.5% (16/110) hospitals used methylene blue and radioisotope simultaneously. Almost all the hospitals (107/110, 97.27%) used intraoperative frozen section for pathological diagnosis of sentinel lymph node (SLN). Most of the hospitals (61/110，55.45%) accepted omitting ALND for less than 10% of cN ₀ patients with 1 or 2 positive SLNs who received BCS. A total of 84 hospitals (76.36%) performed ALND for less than 10% of those patients with clinically axillary node-negative breast cancer, mastectomy and 1-2 metastatic SLNs. Fifty (45.45%) hospitals performed SLNB after NAC, and other 60 (54.55%) hospitals performed SLNB before NAC. Hospitals with more NAC performed (χ ² =4.365, P=0.037) and magnetic resonance imaging (MRI) routinely used for NAC assessment (χ ² =10.967, P=0.004) were more inclined to perform SLNB after NAC. Conclusion: Although the standard application of mapping agent needs to be improved, SLNB has become the standard surgical procedure for early breast cancer patients in China. For breast cancer patients with low sentinel lymph node metastasis load, domestic surgeons are still relatively conservative in omitting ALND. The timing of SLNB in patients who received NAC is still controversial.

Key words: Breast cancer, Sentinel lymph node biopsy, Questionnaire survey