| Objective:Sentinel lymph node biopsy (SLNB) has become standard surgical treatment for axillary surgery in primary breast cancer. Our study aims to explore the correlation between sentinel lymph node status and clinicopathological characteristics in breast cancer.Methods:Firstly, our study assessed the axillary lymph node (ALN) status of patients with breast diseases and normal people via ultrasonic examination. The characteristics of their axillary ultrasound were taken into consideration to predict the sentinel lymph node (SLN) status of malignant patients. Secondly, we retrospectively analysed the clinical and pathological data of malignant patients received breast surgery in Qilu Hospital of Shandong University since January 2013 to January 2016 to explore the lymphatic drainage and the metastatic pattern of ALNs. We compared the identification rate of SLNs marked by blue dye (methylene blue) and blue dye combined with fluorochrome (indocyanine green, ICG) and studied the diagnostic value of SLNs in frozen section (FS) and which combined with touch imprint (TI) cytology. Finally, we established the nomogram of SLN metastasis via selecting the cutoff value of receiver operating characteristic curve (ROC) by analysing and filterating the risk factors of sentinel lymph node metastasis, establishing regressive equation and calculating the predictive value of all patients. Using the SPSS 17.0 statistical software for data processing, univariate analysis were performed by Student’s t test or no n-pare me trie test or chi-square test and multivariate analysis by stepwise Logistic regression.Results:The involved side average length of malignant patients is notably longer than the other side, normal people and benign patients’. Bilateral lymph node of benign patients and normal people has no statistic difference, and the same result was found in both groups. We found that the rate of ALN metastasis was 39.7%(636/1601), most of them descend from group Ⅰ to group Ⅱ to group Ⅲ. "Skip metastasis" were found in 4 patients (0.6%), the positive rate of SLN as 30.1%(44/146) and the FNR was 12% (6/50). The IR of methylene blue marked group was 95.5%(85/89) and the FNR was 11.8%(4/34), however the IR of methylene blue combined with ICG marked group was 100%(41/41) and the FNR was 0%(0/10). All 146 patients had frozen section, 44 had positive SLNs and 102 had negative ones.50 had positive ALNs and 96 had negative ones in routine pathology, the accuracy was 95.9%(140/146).50 patients had positive ALNs and 6 of them had negative SLNs, the FNR wasl2%(6/50).39 patients had frozen section and touch imprint, the accuracy was 100%(41/41), and the FNR was 0%(0/11). The incidence of positive SLN was related with patient age, tumor histological type, E2 and Her-2.Conclusions:In our study, the size of ALNs can be a preoperative assessment index, combining with other indexes to predict the metastasis of SLNs. The ALN metastasis is mostly carried out in the order from group Ⅰ to group Ⅱ to group Ⅲ, but the "skip metastasis" does exist. The rate of "skip metastasis", level Ⅱ, level Ⅲ and the rotter lymph nodes is very low. Thus, sentinel lymph node biopsy is safe and feasible for most patients. But for patients with risk factors above, complete axillary lymph nodes dissection or sentinel lymph node biopsy plus level I lymph nodes dissection is recommended.The rate of positive SLNs is 30.1%, and the incidence was related with patient age, tumor histological type, E2 and Her-2. The false negative rate is 12%, we found that it may have a connection with the expanding operation indications. Since the FNR is very low, SLNB is safe and feasible for most patients with primary breast cancer. But for patients with risk factors above, sentinel lymph node biopsy may have high risk. |
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