Study On False Negative Rate Of Sentinel Lymph Node Biopsy And Response To Neoadjuvant Chemotherapy In Metastatic Lymph Nodes Of Breast Cancer

1?Study on false negative rate of sentinel lymph node biopsyObjective: A cohort analysis was carried out to analyze the effect of different tracer methods on sentinel lymph node biopsy for invasive ductal carcinoma,and further explore the influences to false negative.Methods: We analyzed a total of 588 patients who underwent sentinel lymph node biopsy and axillary lymph node dissection from 2010 to 2016 in our center.The tracer effect of different methods was analyzed,and whether age,stage,molecular subtype and neoadjuvant chemotherapy could influence false negative rate was also analyzed.Results: Of four tracer methods,the false negative rate of dye group was 11.0%,the nuclide + dye group was 6.1%,the fluorescence + dye group was 10.0%,the fluorescence + nuclide + dye group was the lowest,0%(P=0.213>0.05).For all the 50 false negative patients,the age,molecular subtype had no statistical difference with the false negative rate,while stage,neoadjuvant chemotherapy had(P< 0.05).Conclusion: False negative rate of different methods had no statistical difference,because of no radioactivity,we recommend fluorescence + dye to be used as the best tracer method.Further analysis found stage and neoadjuvant chemotherapy had statistical difference on the false negative rate in SLNB(P< 0.05): stage T2 had higher rate than stage T1;after neoadjuvant chemotherapy the false negativerate was higher than those who had not undergone neoadjuvant chemotherapy before SLNB.We couldn't think age,molecular subtype had statistical difference on the false negative rate.2?NSLN metastasis in breast invasive ductal carcinoma patients with 1-2 positive SLNs Objective: To analyze the metastasis of non-sentinel lymph node(NSLN)in breast invasive ductal carcinoma patients with 1-2 positive sentinel lymph nodes.Methods: A total number of 220 patients with breast invasive ductal carcinoma with 1-2 positive sentinel lymph nodes in Department of Breast Surgery,Southwest Hospital,Third Military Medical University from January 2010 to October 2015 were enrolled in this study.All patients underwent SLNB,which confirmed the metastases of 1 to 2 SLNs and then they underwent radical mastectomy.NSLN metastases were pathologically analyzed after opeation.The relationship between NSLN metastases and molecular subtypes,staging of primary tumor,neoadjuvant chemotherapy,ER,PR,HER-2 and Ki67 index were analyzed by c2 test.The relationship between NSLN metastases andpatients' age was analyzed by nonparametric test.Results: Totally,91 cases(91.4%,91/220)had positive NSLNs after ALND,of which 90 cases had axillary lymph node metastasis in stage ?,and only 1 case had lymph node metastasis in both stage?and ?;129 cases were NSLNs negative,accounting for 58.6%(129/220).The molecular subtypes,staging of primary tumor,neoadjuvant chemotherapy,ER,PR,and Ki67 index showed no significant effect on NSLN metastasis(c2= 1.830,1.336,0.918,0.074,0.86,1.766,Z=-1.369;P= 0.608,0.248,0.338,0.786,0.986,0.184,0.171).In 57 HER-2 positive patients,30 were NSLNs positive,with the positive rate of 52.6%(30/57);in 163 cases of HER-2 negative patients,61 were NSLNs positive,with the positive rate of 37.4%(61/163).The positive rate of NSLN in HER-2 positive patients was significantly higher than that in HER-2 negative patients(c2= 4.027,P=0.045).Conclusions: The breast invasive ductal carcinoma patients with 1 to 2SLNs positive are in high risk of NSLN metastasis,especially in patients with HER-2 positive.Therefore further treatment should be performed.3?Response to neoadjuvant chemotherapy in metastatic lymph nodes of breast cancer and its related factorsObjective: A cohort analysis of response to neoadjuvant chemotherapy of metastatic lymph nodes in breast cancer was carried out and we explored the factors influencing its chemotherapy response.Methods:64 patients were included in our study,63 female patients and 1 male.Except the pathological biopsy on the primary tumor,we did axillary lymph node biopsy under ultrasound guidance(61 by core-needle and 2 mammotome)and made sure it's metastatic;having undergone modified radical mastectomy and received chemotherapy,1 patient going for Da Vinci robot-assisted internal mammary lymph node excision was included in our study.Patients with metastatic lymph nodes received neoadjuvant chemotherapy and then pathological evaluation of chemotherapy response in metastatic lymph nodes.The evaluation standard was cited from Expert consensus on pathological diagnosis of breast cancer after neoadjuvant chemotherapy in China.Results:63 patients' result of response to NAC:2 patients got grade I in primary tumor,result was all response visible but not get negative in node.12 patients got grade II in primary tumor,9 patients' result was response visible,1 not visible,but not get negative in node;1 patient' result was response visible and got negative in node.19 patients got grade III in primary tumor,14 patients' result was response visible,1 not visible,but not get negative in node;3 patients' result was response visible,1 not visible and got negative in node.18 patients got grade IV in primary tumor,8 patients' result was response visible,1 not visible but not get negative in node;5 patients' result was response visible,4 not visible and got negative in node.12 patients got grade V in primary tumor,3 patients' result was response visible but not get negative in node;6 patients' result was response visible,3 not visible and got negative in node.The effect of neoadjuvant chemotherapy on lymph node metastasis and primary tumor was not completely consistent.12 patients got grade V in primary tumor,however,there were 3 of them didn't get negative in node.51 patients didn't get grade V,however,t here were 14 of them got negative in node.Conclusions:In this study,a method of evaluation and classification for response to neoadjuvant chemotherapy of metastatic lymph nodes in breast cancer was established.We could use this method to evaluate response to NAC of metastatic lymph nodes.Its clinical significance needs further study.The effect of neoadjuvant chemotherapy on lymph node metastasis and primary tumor was not completely consistent.No metastatic lymph node got negative in Luminal A.75% metastatic lymph node got negative in TNBC,response was visible in all TNBC nodes.