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您当前位置:桓兴肿瘤医院 > 桓兴医讯 > 桓兴医讯 在经活检证实淋巴结阳性乳腺癌患者中新辅助化疗后的前
桓兴医讯 在经活检证实淋巴结阳性乳腺癌患者中新辅助化疗后的前
文章来源:北京市朝阳区桓兴肿瘤医院 点击数: 发布时间:2014-12-09 09:22
《临床肿瘤杂志》2014年12月1日在线先发
在经活检证实淋巴结阳性乳腺癌患者中新辅助化疗后的前哨淋巴结活检:一项SN FNAC研究
目的
越来越大比例的(>30%)淋巴结阳性乳腺癌患者将获得新辅助化疗(NAC)后腋窝病理的完全缓解。如果前哨淋巴结(SN)活检(SNB)在此设置是准确的,就可以避免完全淋巴结清扫术(CND)的发病率。
患者和方法
在未来的多中心SN FNAC的研究中,活检证实为淋巴结阳性的乳腺癌患者(T0-3,N1-2)均接受SNB和CND。免疫组织化学(IHC)的使用是强制性的,任何范围的SN转移,包括孤立的肿瘤细胞(ypN0[1 +],≤0.2毫米),都被认为是阳性。最佳SNB识别率(IR)≥90%和假阴性率(FNR)≤10%是预定的。
结果
2009年3月至2012年12月,153例患者参与了该项研究。前哨淋巴结活检识别率为87.6%(145例中有127例;95%CI为82.2%至93.0%),而假阴性率为8.4%(83例中有7例;95%CI为2.4%至14.4%)。如果SN ypN0(1 +)被视为阴性,FNR将增加至13.3%(83中有11例;95%CI为6.0%至20.6%)。SN转移的范围和非SN阳性的比率之间没有相关性。使用该方法,30.3%患者有可能避免CND。
结论
活检证实为淋巴结阳性的乳腺癌在新辅助化疗后,较低的前哨淋巴结活检假阴性率(8.4%)可以通过强制使用IHC来实现。任何范围的SN转移应被视为阳性。前哨淋巴结活检识别率为87.6%,鉴于技术故障的存在,应该进行腋窝淋巴结清扫。我们建议,在被列入今后的NAC后使用SNB指南之前,使用IHC SN评估需进一步评估。
北京桓兴肿瘤医院 桓兴医讯编译组 田立霞
2014年12月9日 星期二
Published online before print December 1, 2014, doi:10.1200/JCO.2014.55.7827JCO December 1, 2014JCO.2014.55.7827
Sentinel Node Biopsy After Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: The SN FNAC Study
Purpose An increasing proportion of patients (> 30%) with node-positive breast cancer will obtain an axillary pathologic complete response after neoadjuvant chemotherapy (NAC). If sentinel node (SN) biopsy (SNB) is accurate in this setting, completion node dissection (CND) morbidity could be avoided.
Patients and Methods In the prospective multicentric SN FNAC study, patients with biopsy-proven node-positive breast cancer (T0-3, N1-2) underwent both SNB and CND. Immunohistochemistry (IHC) use was mandatory, and SN metastases of any size, including isolated tumor cells (ypN0[i+], ≤ 0.2 mm), were considered positive. The optimal SNB identification rate (IR) ≥ 90% and false-negative rate (FNR) ≤ 10% were predetermined.
Results From March 2009 to December 2012, 153 patients were accrued to the study. The SNB IR was 87.6% (127 of 145; 95% CI, 82.2% to 93.0%), and the FNR was 8.4% (seven of 83; 95% CI, 2.4% to 14.4%). If SN ypN0(i+)s had been considered negative, the FNR would have increased to 13.3% (11 of 83; 95% CI, 6.0% to 20.6%). There was no correlation between size of SN metastases and rate of positive non-SNs. Using this method, 30.3% of patients could potentially avoid CND.
Conclusion In biopsy-proven node-positive breast cancer after NAC, a low SNB FNR (8.4%) can be achieved with mandatory use of IHC. SN metastases of any size should be considered positive. The SNB IR was 87.6%, and in the presence of a technical failure, axillary node dissection should be performed. We recommend that SN evaluation with IHC be further evaluated before being included in future guidelines on the use of SNB after NAC in this setting.
http://jco.ascopubs.org/content/early/2014/12/01/JCO.2014.55.7827.abstract

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