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目的探讨乳腺癌病人新辅助化疗后前哨淋巴结活检的可行性。方法对2003年11月至2004年10月住院治疗中的57例Ⅱ、Ⅲ期乳腺癌病人行新辅助化疗后,临床检查腋窝淋巴结阴性行前哨淋巴结活检术(SLNB)。结果57例中检出前哨淋巴结(SLN)53例,检出率93·0%。SLN对腋窝淋巴结状况预测的敏感性为89·7%,特异性为100·0%,准确性为94·3%,阳性预测值为100·0%,阴性预测值为88·9%,假阴性率为5·7%。肿瘤对化疗反应为CR(完全缓解)、PR(部分缓解)和SD(稳定)的SLN检出率分别为100·0%、96·7%和70·0%(P<0·01)。SLN假阴性3例均为腋窝淋巴结转移数>4个者。结论Ⅱ、Ⅲ期乳腺癌实施新辅助化疗后,行SLNB可获得与早期乳腺癌SLNB相似的效果。
Objective To investigate the feasibility of sentinel lymph node biopsy in patients with breast cancer after neoadjuvant chemotherapy. Methods 57 patients with stage II and III breast cancer who underwent inpatient treatment from November 2003 to October 2004 underwent neoadjuvant chemotherapy and were clinically examined for axillary lymph node-negative sentinel lymph node biopsy (SLNB). Results Among the 57 cases, 53 sentinel lymph nodes (SLNs) were detected, the detection rate was 93.0%. SLN had a sensitivity of 89.7%, a specificity of 100.0%, an accuracy of 94.3%, a positive predictive value of 100.0%, a negative predictive value of 88.9% and a false negative predictive value of 89.9% The negative rate was 5.7%. The tumor response to chemotherapy was CR (complete remission), and the detection rates of PR (partial response) and SD (stable) were 100.0%, 96.7% and 70.0%, respectively (P <0.01). Three cases of SLN false negative were axillary lymph node metastases> 4. CONCLUSION: After neoadjuvant chemotherapy for stage II and III breast cancer, SLNB can achieve similar effects as SLNB of early stage breast cancer.