The Clinical Research Of Non-sentinel Lymph Node Without Metastases Avoid Axillary Lymph Node Dissection In Early Breast Cancer Patients

ObjectiveAnalysis and comparison of metastasis situation of non-sentinel lymph node in early breast cancer patients with sentinel lymph node micro-metastasis, study the security and feasibility of sentinel lymph node biopsy(SLNB) instead of axillary lymph node dissection(ALND) when SLN has the micro-metastasis.MethodsIn patients(T1-2N0M0) with early breast cancer, we will send all the sentinel lymph nodes(SLNs) which we use the methylene blue to locate and find in the operation to have frozen section and routine pathological examinations. This study divide into two stages to finish. The first stage: we are going to give the patients the axillary lymph node dissection and total mastectomy or breast conserving surgery whatever sentinel lymph node(SLN) have no metastases or micro-metastasis or macro-metastasis. The second stage: the patients will have the total mastectomy or lumpectomy with patients supporting no ALND when SLN is negative, otherwise, we will provide the patients with ALND and total mastectomy or lumpectomy when SLN is micro-metastasis or macro-metastasis. Whichever kind of surgery, we are going to give the patients routine adjuvant chemotherapy after the operation, including chemotherapy, radiotherapy, endocrine therapy and molecular targeting therapy, breast conserving surgery having the radiotherapy in the residual breast and the patients with no ALND having no radiotherapy in the axillary. And then, we will collect the data to have the statistical analysis and study the security, feasibility of SLNB instead of ALND whenSLN is micro-metastases and compare the complications between the SLNB and the ALND.Result1、In our study, the total detection rate of 217 SLNs is 93.1%(202/217), the detection rate of the first stage is 91.9%(103/112) and the detection rate of the second stage is 94.2%(99/105).2、The false negative rate of the SLN in our study is 3.23%.3、The age, tumor position, tumor clinical stage, tumor pathological type, tumor histological grade of the patients all have no significantly statistical analysis between the first stage and the second stage(P >0.05).4、The number of SLN we find and corresponding the number of patients also have no significantly statistical analysis in both stages(P >0.05).5 、 The number of the patients whose SLN have the micro-metastasis and the macro-metastasis and the number of SLN with metastasis between the first and the second stage all have no significantly statistical analysis(P >0.05).6、In patients with SLN negative and micro-metastasis, all the non-sentinel lymph nodes(NSLNs) have no macro-metastasis, and the rate of NSLN micro-metastasis in both groups also have no significantly statistical analysis(P >0.05).7、The smaller the rate of the metastasis number of SLN divided by the detected number of SLN is, the lower the risk of NSLN with metastasis is,there is an obvious statistical analysis. And the NSLN all have no micro-metastasis and macro-metastasis in patients with only one SLN having macro-metastasis when the number of SLN found in the operation is bigger than two(P >0.05).8、The SLNB group have less axillary region pain 、upper limb numbness、upper arm edema and upper limb activity obstacle when comparing with the SLNB+ALND group(P <0.05)Conclusion1、Non-sentinel lymph node have no macro-metastasis when the sentinel lymph node only have the micro-metastasis, however, the rate of non-sentinel lymph node with micro-metastasis is similar between the SLN negative group and the SLN micro-metastasis group, both have no significantly statistical analysis. The above results prove that axillary lymph node can be avoided dissecting when sentinel lymph node have micro-metastasis, that is to say, SLNB instead of ALND is safety.2、The smaller the rate of the metastasis number of SLN divided by the detected number of SLN is, the lower the risk of NSLN with metastasis is,and there is an significantly statistical analysis(P <0.05). It is also possible that only one SLN with macro-metastasis can be avoided to dissect the axillary lymph node when the number of SLN is bigger than two. Of course, we are not sure to get this conclusion because of few samples, we will keep our research in the clinic. In addition, we should be more patient and careful to find more SLN when we are having the SLNB in the operation.3、It will further decrease the operation complications by means of SLNB instead of ALND when we are having the SLNB.