Study Of Ultrasound-guided Needle Biopsy For Detecting Axillary Lymph Node Metastasis In Breast Cancer And Expression Changes Of Er, Pr, Ki-67 And Her-2 In Neoadjuvant Chemotherapy Therapy Of Breast Cancer

Background Recent years, the incidence of breast cancer kept rising, dominating the first position among much malignant cancer which harms female’s health. The axilla was recognized as the most common site of metastatic spread of breast cancer. Axillary lymph node status still remains the single most important prognostic factor and forms one of the main determinants of adjuvant systematic treatment in patients with breast cancer. Nowadays, SLNB has emerged as an alternative to conventional ALND for evaluation of axillary lymph node status of early-stage breast cancer patients that can significantly lower the risk of operative complication. It is necessary to find a diagnostic method which is more accurate and less injured. UNB, can provide histopathological diagnosis, has been widely adopted for node staging. Furthermore, NACT as an important part of comprehensive treatments of breast cancer has been increasingly used for patients. It is vital for us to select different treatments and predict therapeutic effectiveness according to the expression of ER, PR, Her-2 and Ki-67.Objective To analyze the clinical value of ultrasound and UNB in the evaluation of axillary lymph node metastasis for breast cancer. We detect the expression of ER, PR, Her-2, Ki-67 before and after NACT in breast cancer patients.Methods A total of 454 cases of breast cancer with abnormal ultrasonic diagnosis of axillary lymph nodes treated between June 2008 and August 2014 at our hospital were retrospectively analyzed. The age of patients was between 27~79, with a median age of 49. All of the cases were diagnosed as breast cancer by histopathological examination. UNB was performed on patients with abnormal ultrasonic diagnosis of axillary lymph nodes. The patients were not treated with chemotherapy, endocrine therapy and radiotherapy before UNB. Among them, 354 cases underwent neoadjuvant chemotherapy or endocrine therapy while 100 cases underwent surgery after UNB. The sonographers estimated the axillary lymph node metastasis status according to ultrasonography and combined their experience. They recorded the size of ultrasound imaging abnormal lymph nodes and measured the lymph node longitudinal and transversal(L/T) at the same time. Analyze the expression changes of ER, PR, Ki-67, Her-2 after neoadjuvant chemotherapy therapy in breast cancer of 208 cases. The evaluation criterion of ER、PR、Her-2、Ki-67:(1)The classification of immunohistochemistry in ER and PR:(1)(-)—Not detected stained cell(2)(+)—The number of stained cells is between 1%~49%(3)(++)—The number of stained cells is between 50%~75%(4)(+++)—The number of stained cells is more than 75%.(2)Define Her-2(-) and Her-2(+) as negative expression of Her-2.If the expression of Her-2 is(++), it is necessary to carry on fluorescence in situ hybridization(FISH).Define FISH(-) and Her-2(+++) as positive expression of Her-2.(3) Ki-67 is low expression when it is less than 14%. Ki-67 is high expression when it is greater than or equal to 14%. Statistical data on the use of SPSS 19.0 statistical software package to carry on Chi-square test, Kappa consistency test and calculate the area under ROC curve, P<0.05 indicates statistically significant.Results Among the 454 patients with abnormal axillary lymph nodes of ultrasound imaging, the metastasis rate with UNB was 70.9%, while the negative rate was 29.1%. Among the 100 cases who underwent surgery after UNB, the metastasis rate was 25% while the ultrasound imaging lymph node longitudinal and transversal(L/T)≤1.5, the lymph node size>1 cm, and the metastasis rate was 92.3%(12/13).UNB showed that sensitivity was 64.1%, specificity 100%, accuracy 86%, positive predictive value 100%, negative predictive value 81.3%, and false negative rate was 18.7%. The results of UNB seemed consistent with those of postoperative pathological diagnosis, the Kappa value being 0.685. Based on 2 and 3 needles, the above mentioned 6 indices were 50% and 77.8%, 100% and 100%, 77.8% and 92.5%, 100% and 100%, 71.4% and 89.7%, and 28.6% and 10.3%, respectively. The Kappa value of UNB based on 3 needles was higher than on 2 needles(0.822 vs 0.526). NACT changed the level of expression of PR and Ki-67.12.9% of the cases appeared to change from positive expression to negative expression in PR. 38.5% of the cases appeared to change from high expression to low expression in Ki-67. Both of them were statistically significant(P<0.05). The expression of ER and Her-2 before and after NACT were not statistically significant(P>0.05).Conclusions Ultrasound is a valuable tool for detecting axillary lymph node metastasis in breast cancer. UNB can accurately determine the axillary lymph node metastasis status. UNB based on 3 needles shows a higher accuracy than on 2 needles.Some cases appeared to change the expression level in ER, PR, Her-2, Ki-67.NACT can decrease the positive expression rate of PR and the high expression level of Ki-67. Patients whose ER, PR, Her-2 changed from negative expression to positive expression after NACT obtain the opportunity to be treated with endocrine and targeted therapy again.