乳腺癌新辅助化疗后前哨淋巴结活检术的临床价值

发布时间：2018-01-17 13:14

本文关键词：乳腺癌新辅助化疗后前哨淋巴结活检术的临床价值　出处：《昆明医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：[目的]前哨淋巴结活检术是乳腺外科研究的热点,而新辅助化疗能使原发肿瘤及区域淋巴结降期,新辅助化疗后前哨淋巴结活检的高假阴性率成为阻碍新辅助化疗后行前哨淋巴结活检术的主要原因,本研究通过对乳腺癌新辅助化疗后临床检查淋巴结阴性的患者进行前哨淋巴结检测,探讨新辅助化疗对前哨淋巴结活检结果的影响。[方法]研究对象为2014年12月至2016年2月在云南省肿瘤医院乳腺外科经病理确诊的原发性乳腺癌患者共195例。105例乳腺癌患者进行新辅助化疗8个周期,化疗方案为EC-T方案。90例患者确诊后直接行手术。所有患者均行前哨淋巴结活检术及腋窝淋巴结清扫术。两组分别计算前哨淋巴结的检出率、准确率、假阴性率,并对组间差异进行统计学分析。[结果]新辅助化疗疗效：105例患者,临床完全缓解(cCR)14例,临床部分缓解(PR)84例,病情稳定(SD)7例,临床完全缓解(pCR)6例。前哨淋巴结活检的结果：新辅助化疗组105例患者有97例检出前哨淋巴结,检出率为92.7%。在97例检出前哨淋巴结的患者中,前哨淋巴结呈阳性的为41例,前哨淋巴结呈阴性的为56例,前哨淋巴结唯一阳性的为9例。准确率为93.8%(91/97),假阴性率为12%(6/50),灵敏度为88%(44/50)。直接手术组90例患者有85例检出前哨淋巴结,前哨淋巴结检出率为94.4%。在85例检出前哨淋巴结的患者中,前哨淋巴结呈阳性的为28例,前哨淋巴结呈阴性的为44例,前哨淋巴结唯一阳性的为9例。准确率为95.3%(81/85),假阴性率为9.8%(4/41),灵敏度为90.2%(37/41)。原发肿瘤大小、位置、腋窝淋巴结情况、新辅助化疗疗效等与前哨淋巴结检出率及假阴性率均无明显关系。[结论]综上所述,新辅助化疗后患者前哨淋巴结检出率、准确率都很高,假阴性率也控制在一定范围之内。在临床上,前哨淋巴结的检测确实能够指导腋窝淋巴结清扫术的进行。因此对新辅助化疗后患者进行前哨淋巴结的检测,能使腋窝淋巴结阴性的患者避免行腋窝淋巴结清扫术,从而减少手术并发症,提升患者的生存质量。
[Abstract]:[Objective] sentinel lymph node biopsy is a hot research of breast cancer surgery, neoadjuvant chemotherapy, the primary tumor and regional lymph node downstaging, high false negative sentinel lymph node biopsy after neoadjuvant chemotherapy hinders the rate of neoadjuvant chemotherapy of sentinel lymph node biopsy the main causes of this research outpost based on the detection of lymph node in breast cancer after neoadjuvant chemotherapy clinical examination of lymph node negative patients, explore new adjuvant chemotherapy on sentinel lymph node biopsy results. Methods from December 2014 to February 2016. The research object in the mammary gland surgery, Yunnan Provincial Tumor hospital diagnosed as primary breast cancer patients with a total of 195 cases of.105 patients with breast cancer underwent 8 cycles of neoadjuvant chemotherapy, chemotherapy EC-T regimen for.90 patients were diagnosed directly after surgery. All patients underwent sentinel lymph node biopsy and axillary lymph node dissection in two. Group calculated the detection rate of sentinel lymph node, accuracy, false negative rate, and the differences between groups were statistically analyzed the efficacy of neoadjuvant chemotherapy. Results: 105 cases of patients, clinical complete remission (cCR) 14 cases, clinical partial remission (PR) 84 cases, stable disease (SD) in 7 cases, clinical complete remission (pCR). 6 cases of sentinel lymph node biopsy results: neoadjuvant chemotherapy group of 105 patients, 97 cases of sentinel lymph node detection, the detection rate of 92.7%. in 97 cases of sentinel lymph node detection in patients with sentinel lymph node positive was 41 cases, sentinel lymph node negative for 56 cases only, sentinel lymph node positive for 9 cases. The accuracy rate was 93.8% (91/97), false negative rate was 12% (6/50), the sensitivity was 88% (44/50). Direct surgery group of 90 patients, 85 cases were detected in sentinel lymph node, sentinel lymph node detection rate of 94.4%. in 85 cases of sentinel lymph node detection in patients with positive sentinel lymph node In 28 cases, sentinel lymph node negative sentinel lymph node in 44 cases, only 9 were positive for. The accuracy rate was 95.3% (81/85), false negative rate was 9.8% (4/41), the sensitivity was 90.2% (37/41). The size of primary tumor, location, axillary lymph node, neoadjuvant chemotherapy the curative effect with sentinel lymph node detection rate and false negative rate had no obvious relationship. Conclusion in summary, after neoadjuvant chemotherapy in patients with sentinel lymph node detection rate, accuracy rate is very high, the false negative rate is controlled in a certain range. Clinically, detection of sentinel lymph node can really guide the armpit lymph node dissection. Therefore the neoadjuvant chemotherapy for patients after detection of sentinel lymph nodes, the axillary lymph node negative patients avoid axillary lymph node dissection, so as to reduce complications and improve the life quality of the patients.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9

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