Study Study Of Analyzing The Causes Of False Negative Sentinel Lymph Node Biopsy Of Breast Cancer And The Corresponding Treatment Plan

Objective: This article aims to analyze the influence of age,tumor size,tumor location,and pathological type on the false negative of sentinel lymph node biopsy(SLNB)for breast cancer,and discuss the double-staining method of SLNB + sentinel lymph node dissection sampling The clinical significance of intraoperative treatment measures to reduce the false-negative rate of SLNB,in order to reduce the false-negative rate of SLNB,prevent missed and missed sentinel lymph nodes,and improve the accuracy,safety and effectiveness of sentinel lymph node biopsy.Methods: From September 2018 to December 2020,a total of 278 patients who underwent breast cancer axillary lymph node dissection(ALND)admitted to Jilin Provincial People’s Hospital and Jilin Provincial Cancer Hospital were collected,and the clinical pathology of all patients in the group was collected.The information is complete and has been informed of the operation method and signed an informed consent form voluntarily before the operation.All enrolled patients need to meet the following criteria:(1)preoperative and/or intraoperative pathologically confirmed as invasive breast cancer;(2)clinical palpation and/or imaging examination before surgery(Axillay lymph node)node,ALN)is suspiciously positive.(3)After the sentinel lymph node(SLN)is resected and submitted for pathology,regardless of whether the SLN has tumor metastasis,the patient agrees to continue ALND.Collect and statistics the clinical pathological data of all patients who meet the enrollment criteria,including age,tumor size,tumor location and pathological type and other observation indicators,and analyze its influence on the false negative of SLNB through statistics.All patients in the group chose to use the methylene blue +nano-carbon suspension combined to trace the SLN.After cutting the colored SLN without destroying the surrounding tissue anatomy,the surrounding SLN was bluntly separated within a diameter of 4 cm around the SLN.Organize,search for the lymph nodes that are visible or palpable with the naked eye,that is,the sentinel lymph nodes,and finally ALND is performed.The SLN,sentinel lymph nodes and the remaining lymph nodes in the axillary were divided into three groups and sent for paraffin pathology.According to the pathological results,the metastasis of SLN,sentinel lymph nodes and ALN tumors were analyzed.Results:1.The correlation analysis results of SLNB false negatives and the patient’s age,tumor size,tumor location,tumor pathological type: SLNB false negatives were not statistically significant in correlation with age,tumor location,and pathological type(P>0.05),while Tumor size is correlated with SLNB false-negative(X2=6.549,P=0.010),the false-negative rate of SLNB in patients with tumor size of 2-5 cm is significantly higher than that of tumor size ≤ 2 cm group(11.5%>7.6%),and there are differences statistically significant(P<0.05).2.The number of SLN detected is correlated with the false negative rate of SLNB((P< 0.05).As the number of detected SLN increases,the false negative rate of SLNB decreases.According to the number of detections of SLN(N),there are five groups with N= 1,2,3,4 and ≥ 5;the false negative rates of pure SLNB are 11.9%,8.7%,7.6%,5.8%,and 3.4%,respectively.It is statistically significant(P<0.05);the false-negative rate of double-stained SLNB + sentinel regional lymph node dissection sampling is 7.1%,5.3%,4.2%,2.8%,2.1%,and the difference is statistically significant(P <0.05)(see Table 3,Figure 5).3.The false-negative rate of double-stained SLNB + sentinel regional lymph node dissection sampling was compared according to the number of SLNs(N=1,2,3,4,≥,5)and found that 1 SLN was detected and 4 were detected.Compared with SLN,the detection of 1SLN and the detection of ≥5 SLN,and the detection of 2 SLNs and the detection of ≥5 SLN,the differences in the results of the three groups were statistically significant(P<0.05),while the other groups The results were not statistically significant(P>0.05)(see Table 4).After double-staining SLNB+Sentinel lymph node dissection and sampling,the number of SLN detections is analyzed after N1=1～2,N2=3～4,N3≥5: When the number of SLN detections is N1=1～2,The false negative rate was significantly reduced after the combined method of SLN sampling,which was statistically significant(P<0.005).When the number of SLN detections is N2=3～4,the false negative rate is reduced to 4.8%(less than 5%),and the result of the decrease in false negative rate is statistically significant(P<0.005).When the number of SLN detections is N3≥5,the false negative rates of the two SLN sampling methods are less than 5%,and the false negative rate is reduced statistically(P <0.05)(see Table 5).Conclusion: 1.The age,tumor location and pathological type of breast cancer patients have nothing to do with the false negative of SLNB,while the size of the primary breast cancer tumor is related to the false negative of SLNB.The false negative rate of SLNB in patients with tumor size> 2 cm and ≤5 cm significantly higher than patients with tumor size ≤ 2 cm.2.The number of SLN detected has an impact on the false negative rate of SLNB.As the number of detected SLN increases,the false negative rate of SLNB will decrease.For patients with a small number of 1-2 SLNs,the double-stained SLNB + sentinel regional lymph node dissection and sampling can play its clinical value in reducing the false-negative rate;the number of SLNs is 3～ At 4 hours,it is recommended to perform the intraoperative treatment measures of double staining SLNB + sentinel lymph node dissection and sampling to further reduce the false negative rate of SLNB;for patients with ≥5 SLN detections,traditional SLNB alone can already accurately assess and predict The metastatic state of ALN does not require intraoperative treatment measures such as double-staining SLNB + sentinel lymph node dissection and sampling.3.Due to the objective existence of differences in the individual breast to axillary lymphatic anatomical structure and the current SLNB operating technology level difference,the false negative rate of breast cancer SLNB can be reduced to an acceptable level,but it cannot be completely reduced to "0".