65Cases Clinical Analysis Of Sentinel Lymph Node Biopsy Combined With Suspicious Lymph Node Sampling In Breast Cancer

Background and objective:Sentinel lymph node biopsy is used more and more widely in the operative treatment of breast cancer, and it is a field with potential research value in breast surgery at present. Through SLNB, the metastasis of axillary lymph node can be comprehended. If sentinel lymph node is negative, the axillary lymph node dissection could be avoided or only low-level lymph node dissection operated, which not only simplifies the operational steps, but also avoids the various postoperative complications. However, the problem of false negative has prevents it further developing. How to reduce the false negative rate of SNLB has become a hot point in current medical research.65patients of primary breast cancer are collected in this study, who has undergone SNLB combined with suspicious lymph node biopsy. Whether this method can significantly reduce the false negative rate compared with single SLNB will be discussed. At the same time, the reasons and counter-measures of false negative problem in sentinel lymphnode biopsy will be further analyzed..Methods:From June2008～July2011,65cases of primary breast cancer who attended Breast Surgery Department of Qan FoShan hospital were collected, all female. Clinical stage Ⅰ or Ⅱ, at the age of29-71years old, average52years old. Axillary lymph nodes suspicious to metastasis(suspicious lymph node) were detected by US and located by hook wire guided by US within preoperative1h. Sentinel lymph node biopsy was implemented though methylene blue staining before preoperative10min. Sentinel lymph nodes and suspicious lymph nodes were removed together during operation, and sended to quick frozen pathology. Dissection scope of axillary lymph node was decided by the result of pathology. All the patients were at least declared the1st level lymph nodes. All of postoperative sentinel lymph nodes、suspicous lymph nodes and axillary lymph nodes were disposed by routine paraffin section, HE staining and immunohistochemistry. The difference in node status prediction between SLNB and SLNB combined with axillary lymph node sampling was compared.Results：64cases were successfully detected sentinel lymph node, for each1-4SLN (considering operation time, the detected number was limited by4), average2.1.61cases were successful detected susceptible lymph node, for each1-3susceptible lymph node, average2.1. There are45cases whose SLN and suspectible lymph node are the same one, and20cases whose are the different. Postoperative paraffin pathology and immunohistochemistry confirmed that there were39cases whose axillary lymph nodes are negative, and26cases positive. Thus, the success rate of single SNLB was98.46%(64/65), false negative rate was15.38%(4/26), the accuracy rate was93.85%(61/65), the sensitivity was84.62%(22/26). The success rate of SNLB combined with suspicious lymph node biopsy was100%(65/65), false negative rate was0%, the accuracy rate was100%(65/65), the sensitivity was100%(26/26). Compared with single SNLB, SNLB combined with suspicious lymph node biopsy can reduce false negative rate dramatically. However, as the number of cases is too same, there has not been shown obvious statistical significance (P=0.1800, X2test).Conclusion:①The cause of false negative result is due to the size of primary tumor、 position of tumor、age of the patients and the methods of pathological examinations.②Compared with single SNLB, SNLB combined with suspectible lymph node sampling can effecitively decrease the occurrence of false negative rate. However, the number of cases collected in this research is too small to have obvious statistical significance. The result need to be confirmed by large sample and multicenter research.