The Study On The Effects Of Neoadjuvant Chemotherapy To Breast Cancer Sentinel Lymph Node Biopsy

Objective:Sentinel lymph node biopsy(SLNB),the rapid development of breast surgery is a very significant progress,is also a hot area of research in present breast surgery.Neoadjuvant chemotherapy enables primary tumor and regional lymph nodes down period,the application of sentinel lymph node biopsy in the patients after adjuvant chemotherapy,there is still much controversy.In this study,84 cases of primary breast cancer after neoadjuvant chemotherapy for axillary lymph node-negative clinical examination of patients with sentinel lymph node biopsy,and 64 patients with primary breast cancer on clinical examination of patients with axillary lymph node-negative sentinel lymph node parallel direct detection of the operation,focused on NAC test results on the impact of SLNB.Study subjects and Methods:from July 2004 to January 2009, Central South University Xiangya Hospital for treatment of breast Section total of 148 patients with breast cancer.84 of them after admission by the Bard-needle aspiration of breast cancer patients diagnosed as pathological,the 2-4 cycles of neoadjuvant chemotherapy, neoadjuvant chemotherapy for the end of radical surgery later before SLNB.Another 64 people admitted to hospital directly after the surgical patients,preoperative puncture or intraoperative rapid pathological examination diagnosed with breast cancer,the same radical surgery before SLNB.All patients with primary breast cancer are women.Age 29-62 years old,median age 47 years.According to the 2008 clinical practice guidelines for breast cancer,clinical stage:ⅡA period of 47 cases,ⅡB period of 43 cases,ⅢA14 cases.Pathological type of invasive ductal carcinoma of 145 cases,two cases of intraductal carcinoma,atypical medullary carcinoma in 1 case.Chemotherapy to patients on clinical examination after axillary lymph node negative.The main drugs used LOH ring based combination chemotherapy, the CEF(cyclophosphamide,epirubicin and fluorouracil) program were 41 cases,the CAF(cyclophosphamide,pirarubicin and fluorouracil) program were 29 cases of,TAC(docetaxel,pirarubicin and cyclophosphamide) were 14 cases of the program.84 patients with neoadjuvant chemotherapy were completed in 3-7 days after surgery, another 64 patients admitted to hospital directly after the surgery,after the completion of SLNB,the modified radical mastectomy.Appear in each division and false-negative patients with the statistical analysis.Results:Neo-adjuvant chemotherapy group 84 patients,SLN were detected in 82 cases,the success rate of 97.6%(82/84),false-negative rate of 17.5%(7/40),successful identification rate 85.4%(70/82).64 Direct surgical patients,found 61 cases of a number of SLN cases,the success rate of 95.3%(61/64),false-negative rate of 25.0%(2/8),successful identification rate 90.2%(55/61).Evaluation of three statistical analysis line,P values were greater than 0.05,there is no statistical significance, that of neoadjuvant chemotherapy on the success rate of SLNB false-negative rate and accuracy of no significant impact.Divided in accordance with the effect of chemotherapy(CR+PR) group and(SD) group,(CR+PR) group of 69 patients,SLN were detected in the number of 68,the success rate of 98.6%(68/69), false-negative rate of 18.7%(6/32),successful identification rate 91.2% (62/68).(SD) group of 15 patients,SLN were detected in the number of 14,the success rate of 93.3%(14/15),false-negative rate of 10.0%(1/ 10),successful identification rate 85.7%(12/14).Evaluation of three statistical analysis line,P values were greater than 0.05,no significant differentIn accordance with the different cycles of neoadjuvant chemotherapy were divided into three groups:2-cycle group,3-cycle and 4 cycle group group.Observations,with the increase in the number of cycles of chemotherapy,the false negative rate increased,accuracy decreased,but statistical analysis three groups of firms,the differences between the three groups,P values were greater than 0.05,not statistically significant.According to the original size of fat mass is divided into(mass＜4cm) group and(mass≥4cm) group.(Mass＜4cm) group of 25 patients,SLN were detected in the number of 25,the success rate of 100%(25/25), false-negative rate of 9.1%(1/11),successful identification rate 84.0% (21/25).(Mass≥4cm) group of 59 patients,SLN were detected in the number of 57,the success rate of 96.6%(57/59),false-negative rate of 20.7%(6/29),successful identification rate 85.9%(49/57).When the mass smaller,the false negative rate was significantly lower than patients with larger tumors.Conclusion:(1),neoadjuvant chemotherapy for breast cancer later in patients with sentinel lymph node detection and direct surgery in patients with sentinel lymph node biopsy,suggesting that the application of SLNB after neoadjuvant chemotherapy in clinical axillary node-negative patients.(2),the present study efficacy of neoadjuvant chemotherapy does not affect the results of sentinel lymph node biopsy,to be confirmed by further studies.(3),with cycles of chemotherapy increased the accuracy of sentinel lymph node biopsy decreased false-negative rate of increase in the trend of increase in the number of cases to be studied in depth.(4),breast cancer when the primary tumor(≥4cm),after neoadjuvant chemotherapy of false-negative rate of SLNB high,suggesting that the larger of the tumor after neoadjuvant chemotherapy for breast cancer line SLNB only high-risk,we recommend that such patients classic line axillary lymph node dissection.