摘要
目的随着早期乳腺癌诊断率的不断提高,乳腺癌的腋窝淋巴结(axillary lymph node,ALN)转移率不断降低。本研究回顾性研究超声对乳腺癌ALN转移的诊断价值,并分析与乳腺癌前哨淋巴结(sentinel lymph node,SLN)转移相关的因素。方法收集2009-01-01-2013-01-01中国人民解放军第三〇七医院初治乳腺癌并行前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的患者357例,SLN转移阳性患者行腋窝淋巴结清除(axillary lymph node dissection,ALND)。分析肿瘤T分期、分子分型与SLN转移的相关性,以及术前B超判断乳腺癌ALN转移的诊断价值。结果SLN总体转移率21.0%(75/357);T1与T2期患者SLN转移率分别为20.6%(40/194)和23.7%(27/114),SLN转移与肿瘤T分期无关,χ2=1.23,P=0.54;Luminal A-like型、Luminal B-like〔人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阴性〕型、Luminal B-like(HER2阳性)型、HER2过表达型和三阴型患者SLN转移率分别为35.0%(14/40)、17.6%(25/142)、25.6%(10/39)、22.2%(8/36)和14.3%(4/28),SLN的转移与肿瘤分子分型无相关性,χ2=6.88,P=0.14;B超判断ALN转移的准确性为68.6%(245/357),敏感性为44.0%(33/75),特异性为75.2%(212/282),阳性预测值为32.0%(33/103),阴性预测值为83.5%(212/254),假阴性率为16.5%(42/254);当SLN转移阳性,B超判断ALN转移阳性患者的非SLN转移率明显高于B超判断转移阴性患者,非SLN转移率分别为72.7%(16/22)和14.3%(6/42),χ2=10.61,P=0.01;B超判断ALN转移阴性患者非SLN淋巴结转移负荷较低,均≤2枚。结论 T1、T2期乳腺癌SLN总体转移率为21.0%(75/357),其转移与肿瘤T分期和分子分型无关;B超可以较准确判断ALN的转移状态;B超判断ALN转移阴性实际转移阳性患者仅有较低的淋巴结转移负荷。
OBJECTIVE With the continuous improvement of the diagnosis rate of early breast cancer, the metastasis rate of axillary lymph node （ALN） dissection breast cancer is decreased continuously. The aims of this study was to retrospectively evaluate the value of ultrasound （US） in predicting the axillary lymph node（ALN） metastasis, and analyze sentinel lymph node（SLN） metastasis related factor. METHODS From January 1, 2009 to January 1, 2013 in the 307th Hospital of Chinese People＇s Liberation Army, 357 new patients of breast cancer were employed, the patients had sentinel lymph node biopsy （SLNB） with or without axillary lymph node dissection （ALND）. The SLN metastasis related factors, such as tumor T stage, tumor molecular classification and US results were analyzed. RESULTS In 357 patients, the SLN overall metastasis rate was 21.0%（75/357）. in T1 and T2 stage patients, the SLN metastasis rates were 20.6% （40/94） and 23.7% （27/114） respectively, χ^2 = 1. 23, P = 0. 54. In Luminal A-like type, Luminal B-like （HER2 - ） type, Luminal B-like （HER2＋） type, HER2 expression type and triple-negative type, the SLN metastasis rates were 35.0%（14/40）, 17. 6%（25/142）, 25.6%（10/39）, 22. 2%（8/36） and 14.3%（4/28）, respectively（χ^2=6.88, P= 0. 14）. The value of US in predicting the ALN metastasis was as follows. The accuracy was 68.6%（245/357）, the sensitivity was 44.0 % （33/75）, specificity was 75.2% （212/282）, positive predictive value was 32. 0% （33/103）, negative predictive value was 83.5% （212/254） and the false negative rate was 16.5% （42/254）. While SLN metastasis positive, the non SLN metastasis rate in patients whose US judged as positive ALN metastasis was significantly higher than these US detected as metastasis negative patients, the non SLN metastasis rate was 72.7%（16/22） and 14.3% （6/42）, respectively （χ^2= 10.61 ,P=0.01）. In the patients of US judged as ALN metastasis negative and the SLN positive, the non S
作者
宋聪睿
白玲
唐英
胡鹏遥
郝晓鹏
陈翠京
尉承泽
SONG Cong-rui BAI Ling TANG Ying HU Peng-yao HAO Xiao-peng CHEN Cui-jing YU Cheng-ze(307th Hospital of Chinese People＇s Liberation Army, Beijing 100071 ,P. R. China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2016年第18期1234-1238,1243,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
国家自然科学基金重点项目(30930038)
国家自然科学基金(81302292)
关键词
乳腺肿瘤
超声
前哨淋巴结活检
术后病理
腋窝淋巴结
breast neoplasms
ultrasound
sentinel lymph node biopsy
pathology after surgery
axillary lymph node
