Reliability Analysis Of Sentinel Lymph Node Biopsy In Different Molecular Typing Breast Cancer

BackgroundIn recent years,despite the achievements in molecular and genetic studies of breast malignancies,the presence or absence of metastases in axillary lymph nodes is still an important factor in evaluating the prognosis of breast cancer,and it determines the choice of subsequent treatment options.At present,axillary lymph node dissection and sentinel lymph node biopsy are two main surgical methods for breast cancer.Axillary lymph node dissection and pathological examination of the resected lymph nodes are the most accurate way to determine if the axillary lymph nodes have metastases.However,a variety of complications such as ipsilateral upper limb lymphadenopathy,sensory numbness,and activity limitation occur after axillary lymph node dissection,which seriously affects the postoperative quality of life.In contrast,sentinel lymph node biopsy can effectively prevent breast cancer patients from providing accurate axillary staging information.At present,sentinel lymph node biopsy is generally recommended for patients with earlystage axillary lymph node-negative in early invasive breast cancer.However,there is still a significant portion of these patients with positive sentinel lymph node biopsy,which does not prevent axillary lymph node dissection.The accurate assessment of the status of the armpit before surgery is conducive to the choice of armpit treatment.Previous studies have shown that different molecular classifications of breast cancer may affect axillary lymph node metastasis,suggesting that we can determine the molecular classification of breast cancer before surgery,to a certain extent,can provide a certain predictive value for the patient’s axillary lymph node status,for follow-up the choice of surgical approach and the assessment of the prognosis provide a meaningful reference.PurposeThis article analyzes the relationship of the four molecular types of breast cancer and sentinel lymph node metastasis,and conducts preoperative assessment of sentinel lymph node status from molecular classification,providing a certain reference for accurate choice of surgical approach.MethodsA total of 158 patients undergoing mastectomy plus sentinel lymph node biopsy were selected from August 2016 to December 2017 at the Department of Breast Surgery,Taian Central Hospital.Inclusion criteria:(1)Breast cancer patients with complete clinical data;(2)No preoperative treatment;(3)Complete immunohistochemical analysis of postope rative pathology;(4)T1 and T2 invasiveness Breast cancer.Exclusion criteria:(1)Bilateral breast cancer;(2)Multicenter breast cancer;(3)Inflammatory breast cancer.According to the markers ER,PR,Her-2 and Ki-67,breast cancers were divided into four molecular subtypes: Luminal A,Luminal B,Her-2 over-expression and triple-negative.Results(1)Of the 158 breast cancer patients included in the study for sentinel lymph node biopsy,27 were Luminal A patients,sentinel lymph node metastasis rate was 22.22%;86 were Luminal B patients,and 62.79% were sentinel lymph node metastasis;16 cases of Her-2 over-expressed patients,the metastatic rate of sentinel lymph node was 43.75%;triple-negative patients with 29 cases and sentinel lymph node metastasis rate was 31.03%.The difference in the rate of sentinel lymph node metastasis in the four molecular types of breast cancer was statistically significant(P<0.05).(2)Compared with Luminal A and triple-negative patients,Luminal B patients had a higher rate of sentinel lymph node metastasis(P<0.008).Compared with patients with Her-2 overexpression type,Luminal B showed higher rates of metastasis,but the differrence was not statistically significant.(3)Tumor size,vascular tumor embolus,and age can affect the rate of sentinel lymph node metastasis in breast cancer(P<0.05).The differences in tumor site,histological grade,and menstrual status have no significant effect on the rate of metastasis of SLNs(P>0.05).ConclusionsThe sentinel lymph node metastasis of different molecular types of breast cancer is different.Luminal B lymph node metastasis rate is higher.If this type of patient is accompanied by relatively young,large tumor size,vascular tumor embolism and other factors,axillary lymph node dissection can be recommended to a greater extent.Therefore,it is suggested to conduct biopsy of breast hollow needles before surgery to define the tumor pathology and molecular classification,and to provide a reference for the choice of surgical methods and the evaluation of prognosis before operation.