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目的研究乳腺癌新辅助化疗后前哨淋巴结活检(SLNB)的可行性和效果。方法利用新型示踪剂——99mTc-利妥昔配合专利蓝染料对60例原发性乳腺癌新辅助化疗后病例进行SLNB,并对SLN进行常规病理检查和免疫组织化学检查。SLNB后常规腋窝淋巴结清扫。结果SLN检测成功率95％(57／60)。SLN转移阳性23例(40%),其中18例为常规病理检查转移阳性(78％),5例为免疫组织化学检出的微转移(22％)。23例SLN有转移病例中,9例同时存在其他腋窝淋巴结转移,另外14例为惟一转移淋巴结。1例SLN转移假阴性。灵敏度96％(23／24),准确性98％(56／57),特异度100％(33／33),假阴性率4．3％(1／23),阴性预测值97％(36／37),阳性预测值100％(24／24)。内乳淋巴结显像11例,活检病理检查均为转移阴性。结论同位素示踪剂和蓝染料联合检测方法对原发性乳腺癌新辅助化疗后进行SLNB同样适用,内乳前哨淋巴结活检不应做常规推荐。
Objective To study the feasibility and effect of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy in breast cancer. Methods A new tracer - 99mTc-rituximab combined with patented blue dye was used to treat SLNB in 60 cases of primary breast cancer after neoadjuvant chemotherapy, and routine pathological examination and immunohistochemical examination of SLN were performed. Conventional axillary lymph node dissection after SLNB. Results The success rate of SLN detection was 95% (57/60). 23 (40%) were positive for SLN metastasis, of which 18 were positive for routine pathology (78%) and 5 were micrometastases (22%) for immunohistochemistry. Among the 23 cases with SLN metastases, 9 cases had other axillary lymph node metastases at the same time, and the other 14 cases were the only metastatic lymph nodes. One case of SLN metastasis false negative. The sensitivity was 96% (23/24), the accuracy was 98% (56/57), the specificity was 100% (33/33), the false negative rate was 4.3% (1/23) and the negative predictive value was 97% 37), the positive predictive value of 100% (24/24). Internal mammary lymph node imaging in 11 cases, biopsy were negative for pathological examination. Conclusion The combination of isotope tracer and blue dye detection method is equally applicable to SLNB after neoadjuvant chemotherapy in primary breast cancer. The sentinel lymph node biopsy should not be routinely recommended.