Clinical Analysis Of 46 Patients With Sentinel Lymph Node Biopsy In Breast Cancer

Background and Objective: It is now that breast cancer has become one of the most common malignant tumors of women and become the second largest cause of death of women for cancer etiology in addition to lung cancer. Its morbidity is tending to increase and become younger. Sentinel lymph node biopsy (SLNB) is based on the assumption that the axillary lymph nodes which first drainage from breast tumor can be accurately identified and biopsied. The full axillary lymph node dissection (ALND) can lead to a series of complications such as upper limb edema, paresthesia and activity obstacle. It could be avoided if the result of sentinel lymph node (SLN) can also accurately reflect the pathological staging of axillary lymph nodes. After a series of prospective randomized controlled study in patients with early breast cancer, SLNB has become a widely recognized lymph node biopsy that could get the accurate axillary lymph nodes staging and improve patients'recovery and quality of life. The detection of SLN can be divided into blue staining, radioisotope method and the combination of the two methods in clinical. Removing the blue stained and/or concentration of nuclide lymph nodes intraoperation indicates the successful location. The effective factors such as surgeon's experience, patient factors, tumor characteristics and choice of tracer methods could affect the accuracy of SLNB. This study aims to investigate the effective factors for the accuracy of SLNB, analyze the different effects with different tracer methods of SLN and lymph node biopsies on surgical process, postoperative recovery and so on.Methods: Retrospective analysis of the clinical data and perioperative information about a total of 46 patients (study group) in early breast cancer (cT0-2N0M0) from September 2007 to March 2010 of the Breast Surgery in the First Hospital of Jilin University, who with negative axillary lymph nodes in physical and assistant examinations and were traced with blue dye, radioisotope + blue dye for SLNB. Randomly selected 30 patients in the same period of early breast cancer (cT0-2N0M0) who were treated with traditional ALND as the control group, respectively compare and analyze the differences for the perioperative information in the study group, and between the study group and the control group.Results: 1. In the study group, 45 cases underwent SLNB successfully and the successful rate was 97.83% (45/46), of which 3 cases were found in low axillary lymph node dissection as a result of higher SLN location; 1 case adopted ALND directly because of the SLN was not imaging intraoperation in blue dye group; in combined group, 1 case was negative proved by quick frozen pathology intraoperation, but confirmed to be sub-micrometastases (metastasis maximum diameter<0.2mm) postoperation by pathological paraffin section whom did not given further surgical treatment afterwards; 1 case in each group was confirmed by quick frozen pathology with SLN metastasis and directly underwent ALND intraoperation. Both of them were confirmed by pathological paraffin section that was only SLN metastasis. Other negative SLNs had been confirmed by pathological paraffin section. 2. Comparison of the blue dye group and combined group, the SLN identification rate were 95% and 100% which have no statistical significance byχ2 test of Fisher exact test (p=0.435>0.05). In addition, the surgical removal time and local drainage time both have no statistical significance (p>0.05) with different tracer methods. Similarly, the peritumoral and periareolar injection of methylene blue also have no statistical significance for the detection rate of SLN (p=1.00>0.05). 3. Comparing with the control group, the study group recovered better postoperation without any postoperative complications. In addition, the surgical removal time and local drainage time were both shorter, which have clear statistical significance (p<0.0001). However, the hospital stays and charges have no statistical differences (p>0.05).Conclusion: 1. SLNB is a minimally invasive and effective lymph node biopsy. Through a strict cases selection, it could take the place of ALND for whom in early breast cancer with negative SLN. 2. There were no upper limb edema, paresthesia, activity obstacle and other common complications which were common after ALND in the study group. SLNB also significantly improved the quality of life. Moreover, the surgical removal time and local drainage time were significantly shortened, which could contribute to reduce the surgical combat.