The Clinical Observation Of The Application Of SLNB Substitute For ALND In Early Breast Cancer

Background and ObjectiveBreast cancer is one of the most common female cancers. It has been widely believed that axillary lymph node status was one of the most important prognostic markers for metastasis-free breast cancer patients[1]. For the reason that the axillary lymph node dissection (ALND) has been identified as the golden standard for axillary lymph node staging, ALND has always been the essential part of traditional operations of breast cancer. Although the ALND provide the most accurate axillary lymph node status, the complications caused by ALND seriously influence the quality of postoperative life, the complications include edema of the upper limb, pain, decreased muscle strength, sensory abnormalities[2,3]. It’s been confirmed by some large sample clinical studies that the ALND did nothing helpful for the improvement of survival rate[4]. Then, after years of study, it has been proved that sentinel lymph node biopsy (SLNB) was an accurate way to stage the axillary lymph node for early breast cancer[5-8] Nowadays, SLNB has been one of the standard therapeutic method of western country[9]. After standard training of learning curve[10], we begin to carry out SLNB substitute for ALND of breast cancer in our department. To confirm the value of SLNB in early breast cancer, we analysed the complications and survival rate differences of SLNB substitute for ALND and ALND only of early breast cancer retrospectively.MethodsOf all the74patients who received SLNB in the department of breast surgery II in the first affiliated hospital of Zhengzhou university from July1st2007to May27th2011, the61patients who received SLNB substitute for ALND were selected as experimental group, selected83breast cancer patients who had complete follow-up data and received ALND of the corresponding period as control group, and whose pathology result of lymph node was no more than1, and whom were early stage.,ResultsOf all the74patients who received SLNB, detection ratio was94.59%(70/74), false negative rate was2.86%(2/70). In the comparison of complications such as lymph oedema, pain, decreased muscle strength, and sensory disturbance of the ipsilateral upper limb, the result of study group is inferior to matched group (p<0.05). In the comparison of the incidence of activity limitation of shoulder joint, the difference between the two groups was statistically significant (p=0.277)ConclusionSLNB substituted for ALND is simple and convenient, safe, reliable, and can avoid the complications produced by ALND. The indication of SLNB should be restrictto early stage breast cancer. SLNB should be the first choise of the patients with the indication of SLNB. The enlarged lymph nodes we find during the operation should be removed meanwhile. The way of use blue dye only to identify sentinel lymph node (SLN) is simple, the cost is low, the material is facile, and it’s suitable for the clinical promotion.