临床查体阴性但超声检查及穿刺确诊腋窝淋巴结转移的乳腺癌前哨淋巴结活检的可行性分析

doi:10.19401/j.cnki.1007-3639.2023.06.004

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (6): 574-580.doi: 10.19401/j.cnki.1007-3639.2023.06.004

临床查体阴性但超声检查及穿刺确诊腋窝淋巴结转移的乳腺癌前哨淋巴结活检的可行性分析

丛斌斌¹^,²^,³(), 曹晓珊¹^,², 王春建¹^,², 邱鹏飞¹^,², 孙晓¹^,², 陈鹏¹^,², 刘雁冰¹^,², 赵桐¹^,², 张朝蓬¹^,², 石志强¹^,², 毕钊¹^,², 王永胜¹^,²()

1.山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心，山东济南 250117
2.山东第一医科大学（山东省医学科学院），山东济南 250062
3.山东大学，山东济南 250100

收稿日期:2023-01-30 修回日期:2023-05-16 出版日期:2023-06-30 发布日期:2023-07-26
通信作者: 王永胜（ORCID：0000-0001-6252-684X），主任医师，山东省肿瘤医院乳腺病中心主任。
作者简介:丛斌斌（ORCID：0000-0002-8026-2988），博士，副主任医师。
王永胜，二级教授、博士研究生导师，现任山东省肿瘤医院大外科主任，山东省肿瘤医院乳腺病中心主任。担任中国抗癌协会乳腺癌专业委员会副主任委员，中国抗癌协会国际医疗交流分会副主任委员，中国临床肿瘤学会乳腺癌专家委员会常务委员，中国医师协会肿瘤分会乳腺癌学组副组长，中华医学会肿瘤学分会乳腺癌学组委员，国家卫生健康委乳腺癌诊疗规范专家组成员，全球乳腺癌大会国际指导专家委员会成员，山东省抗癌协会靶向治疗分会主任委员。于国内率先开展乳腺癌保留乳房手术、前哨淋巴结活检替代腋窝淋巴结清扫术、乳腺病变微创诊断等研究，作为组长单位和首席专家，牵头开展了中国临床早期乳腺癌前哨淋巴结活检替代腋窝清扫术的多中心研究、乳腺癌内乳区前哨淋巴结活检术的多中心前瞻性临床验证研究和新型示踪技术引导乳腺癌内乳前哨淋巴结活检的多中心前瞻性临床研究，研究成果已达到国际领先水平，并参与多项国际和国内乳腺癌Ⅲ期临床研究。以第一作者或通信作者发表论文200余篇，其中在SCI收录期刊上发表论文60余篇，出版专著（译著等）共4部，授权国家发明专利2项，获奖成果共5项，其中国家级1项、部（省）级4项，作为主要负责人承担国家级项目4项、部（省）级项目3项。
基金资助:
山东省自然科学基金(ZR2021QH164);北京医学奖励基金(YXJL-2020-0941-0762);北京医学奖励基金(YXJL-2020-0941-0740);北京科创医学发展基金(KC2021-JX-0044-1)

Feasibility analysis of sentinel lymph node biopsy in breast cancer with axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with biopsy

CONG Binbin¹^,²^,³(), CAO Xiaoshan¹^,², WANG Chuanjian¹^,², QIU Pengfei¹^,², SUN Xiao¹^,², CHEN Peng¹^,², LIU Yanbing¹^,², ZHAO Tong¹^,², ZHANG Zhaopeng¹^,², SHI Zhiqiang¹^,², BI Zhao¹^,², WANG Yongsheng¹^,²()

1. Department of Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan 250117, Shandong Province, China
2. Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250062, Shandong Province, China
3. Shandong University, Jinan 250100, Shandong Province, China

Received:2023-01-30 Revised:2023-05-16 Published:2023-06-30 Online:2023-07-26

摘要/Abstract

摘要：

背景与目的：随着腋窝影像和超声引导活检技术的敏感性不断提高，一部分临床腋窝淋巴结阴性患者提升为临床腋窝淋巴结阳性（clinical lymph node positive，cN₁）并接受了腋窝淋巴结清扫（axillary lymph node dissection，ALND）。本研究旨在分析，临床查体腋窝淋巴结阴性但超声检查发现可疑淋巴结并通过细针抽吸细胞学检查或空芯针活检（fine-needle aspiration cytology/core-needle biopsy pathology，FNAC/CNBP）确诊转移的患者，是否适合进行腋窝前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）。方法：回顾性分析山东省肿瘤防治研究院乳腺病中心2015年10月—2022年12月经治的原发性乳腺癌患者的病历资料，筛选获取术前超声检查发现腋窝可疑的转移淋巴结并通过FNAC/CNBP确诊转移并接受ALND患者的临床资料。所有数据均采用SPSS 27.0统计软件进行分析，P<0.05为差异有统计学意义。结果：其中158例患者术前超声检查发现1~2枚可疑淋巴结经FNAC/CNBP确诊有转移，ALND后发现43.7%（69/158）的患者存在1枚淋巴结转移，15.2%（24/158）存在2枚淋巴结转移，41.1%（65/158）存在2枚以上淋巴结转移。其中，65例（41.1%，65/158）患者接受了SLNB并进行了ALND，SLNB的假阴性率为0%，1~2枚腋窝前哨淋巴结（sentinel lymph node，SLN）转移的患者中61.5%（40/65）未发现非前哨淋巴结（non-sentinel lymph node，non-SLN）转移，发现1、2、3和3枚以上non-SLN转移的比例分别为10.8%（7/65）、4.6%（3/65）、6.2%（4/65）和16.9%（11/65），差异有统计学意义（P=0.042）。结论：临床查体淋巴结阴性但超声检查发现可疑淋巴结并通过FNAC/CNBP确诊1~2枚转移的患者行SLNB是安全可行的，然而这部分患者腋窝淋巴结转移的肿瘤负荷较高，需要更完备的放疗方案和全身治疗计划加强局部控制。

关键词: 乳腺癌, 临床腋窝淋巴结阳性, 前哨淋巴结活检

Abstract:

Background and purpose: With the increasing sensitivity of axillary imaging and ultrasound guided biopsy, some clinically axillary negative patients were upstaged to axillary positive (cN₁) and received axillary lymph node dissection (ALND). This study aimed to assess the feasibility of sentinel lymph node (SLN) biopsy (SLNB) in patients with axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with a fine-needle aspiration cytology/core-needle biopsy pathology (FNAC/CNBP). Methods: This retrospective cohort study included patients with early breast cancer who had axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with a FNAC/CNBP from October 2015 to December 2022 in the Breast Cancer Centre of Shandong Cancer Hospital and Institute. All patients received ALND. The data were analyzed by using SPSS version 27.0 statistical software, and P<0.05 was considered statistically significant. Results: A total of 158 patients were identified to have axilla negative evaluation by physical examination but one to two suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with FNAC/CNBP, 43.7% (69/158) of them had only one ALN metastasis after ALND, 15.2% (24/158) had only two ALNs metastases after ALND, and 41.1% (65/158) had more than two ALNs metastases after ALND. Among these cases, 65 patients received SLNB followed by ALND, and the false negative rate of SLNB was 0%. Positive non-SLN metastasis rate was 0 in the 61.5% (40/65) patients with 1-2 positive SLNs metastasis. One, two, three and more than three non-SLN metastasis rates were 10.8% (7/65), 4.6% (3/65), 6.2% (4/65) and 16.9% (11/65), respectively (P=0.042). Conclusion: SLNB was safe and feasible in patients with axilla negative evaluation by physical examination but one to two suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with a FNAC/CNBP. In these patients, the axillary lymph node tumor burden was high, and exhaustive radiotherapy and systematic treatment were needed to control reginal disease.

Key words: Breast cancer, Clinically axillary lymph nodes positive, Sentinel lymph node biopsy

中图分类号:

R737.9

丛斌斌, 曹晓珊, 王春建, 邱鹏飞, 孙晓, 陈鹏, 刘雁冰, 赵桐, 张朝蓬, 石志强, 毕钊, 王永胜. 临床查体阴性但超声检查及穿刺确诊腋窝淋巴结转移的乳腺癌前哨淋巴结活检的可行性分析[J]. 中国癌症杂志, 2023, 33(6): 574-580.

CONG Binbin, CAO Xiaoshan, WANG Chuanjian, QIU Pengfei, SUN Xiao, CHEN Peng, LIU Yanbing, ZHAO Tong, ZHANG Zhaopeng, SHI Zhiqiang, BI Zhao, WANG Yongsheng. Feasibility analysis of sentinel lymph node biopsy in breast cancer with axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with biopsy[J]. China Oncology, 2023, 33(6): 574-580.

图/表 1

参考文献 25

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Characteristics	Cases n (%)
Total	158
Age/year
Median	49
Range	30-77
BMI/(kg·m^-2)
Median	24.1
Range	17.2-33.5
Tumor T stage
T₁	67 (42.4)
T₂	77 (48.7)
T₃	14 (8.9)
Tumor location
Upper outer quadrant	98 (62.0)
Lower outer quadrant	9 (5.7)
Upper inner quadrant	29 (18.4)
Lower inner quadrant	3 (1.9)
Central	19 (12.0)
Pathological type
Invasive ductal carcinoma	122 (77.2)
Invasive lobular carcinoma	16 (10.1)
Others	20 (12.7)
Breast surgery
BCS	12 (7.6)
Mastectomy	146 (92.4)

临床查体阴性但超声检查及穿刺确诊腋窝淋巴结转移的乳腺癌前哨淋巴结活检的可行性分析

Feasibility analysis of sentinel lymph node biopsy in breast cancer with axilla negative evaluation by physical examination but suspicious lymph nodes finding on preoperative imaging and metastasis confirmed with biopsy

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