| Objective Breast cancer is a malignant tumor with the highest incidence of women.The treatment of breast cancer is essential to improve the survival and quality of life of female patients.At the same time,there are few studies on whether neoadjuvant therapy(NAC)can protect the axilla.Sentinel lymph node biopsy(SLNB)has become the standard detection method for early non-lymph node metastatic breast cancer,but there is still a lot of controversy.This biopsy is also the focus of surgeons.This study explored the feasibility of axillary lymph node-positive patients undergoing NAC,whose downgrade was negative patients and SLNB,to find a method to accurately assess the axillary lymph node status.Methods Prospective data were obtained from clinical data of patients from the Affiliated Hospital of Qingdao University.These patients completed a 4-cycle TA program or a6-week TAC program or EC×4-T in the breast disease diagnosis and treatment center from January 2018 to December 2019.×4 regimen or TCb(H)×6 cycles of treatment,and then completed NAC before surgery and the axillary lymph node degeneration was clinically negative,and received SLNB and axillary lymph node dissection(ALND)at this center.SLNB uses methylene blue alone Tracer or methylene blue combined with indocyanine green double tracer method for detection.The specific steps of the single tracer method are as follows: After the patient is successfully anesthetized,1ml of 1%methylene blue is injected subcutaneously or intradermally in the areola of the affected side,the skin is cut after 10-15 minutes of massage,and the blue stain is found along the blue stained lymphatic vessel Lymph node,and remove the lymph node,labeled SLN.The specific steps of the dual tracer method are as follows: After the patient is successfully anesthetized,1 ml of 1% methylene blue and 1% indocyanine green are injected into the affected areola or subcutaneously,and the skin is cut after 10-15 minutes of massage.Under the guidance of the indocyanine green detector,look for the blue-stained and/or fluorescent imaging lymph nodes along the blue-stained lymphatic vessels and fluorescence,and cut off the lymph nodes,marked as sentinel lymph nodes.If suspicious lymph nodes are found during the operation,the frozen pathology will be removed during the operation.Finally,axillary lymph node dissection is performed.The specific operation of ALND is as follows: at the original incision of the sentinel lymph node biopsy,and clean the lymph nodes of the axillary groups ? to ? according to the specifications.Finally,the blood vessels of the breast are ligated,and the nerves in the corresponding area should be protected during the operation.This study compares the pathological results of SLNB and ALND,analyzes the detection rate,false negative rate,accuracy rate and sharpness of SLNB,and stratifies the possible influencing factors.Results A total of 86 patients were enrolled in the study,with an average age of 52.3years and a span of 26 to 72 years.Of these,44 were premenopausal(51.2% of the total enrolled group),and 42 were postmenopausal(accounted for the total enrolled group)48.8% of the number).The tumor staging of the enrolled patients was mostly T1(33 cases,accounting for 38.4% of the total enrollment)and T2(36 cases,accounting for 41.9% of the total enrollment),and the lymph node staging was N1(79 cases,accounting for the total enrollment)91.9% of the group number).23 patients with Luminal A type(accounting for 26.7% of the total enrollment),16 patients with Luminal B type(accounting for 18.6% of the total enrollment),and 19 patients with triple negative patients(accounting for 22.1% of the total enrollment),28 cases of human epidermal growth factor 2(HER2)overexpression type(hormone receptor negative)(accounting for32.6% of the total enrollment).50 patients(accounting for 58.1% of the total enrollment)BMI<25kg/m2,36 patients(accounting for 41.9% of the total enrollment)BMI ? 25kg/m2,60 patients(accounting for 69.8% of the total enrollment))The patient has no family history of cancer.In addition,47 patients(54.7% of the total enrolled group)received methylene blue single tracing for SLNB,and 39 patients(45.3% of the total enrolled group)received methylene blue combined with indocyanine green dual display Tracking method;35 patients(40.7%)had less than 3 SLNs removed,and 51 patients(59.3%)had ?3 removed.The pathological complete remission rate of breast lumps was29.1%(25/86).The complete remission rate of axillary pathology was 36.0%(31/86),and the overall detection rate,false negative rate,accuracy and sensitivity were 100%(86/86),16.4%(9/55),89.5%(77/ 86)and 83.6%(46/55).The detection success rate,false negative rate,accuracy rate and sensitivity of methylene blue single tracer method are100%(47/47),20.0%(6/30),87.2%(41/47)and 80.0%(24/30);the success rate,false negative rate,accuracy rate and sensitivity of methylene blue combined with indocyanine green double tracing method were 100%(39/39),12.0%(3/25),92.3 %(36/39)and88.0%(22/25)(Table 2).Sentinel lymph node removal <3 patients The success rate,false negative rate,accuracy and sensitivity of sentinel lymph node biopsy were 100%(35/35),29.2%(7/24),80.0%(28/35)and 70.8%,respectively(17/24);the success rate,false negative rate,accuracy rate and sensitivity of taking out ?3 pieces are 100%(51/51),6.5%(2/31),96.1%(49/51)and 93.5% respectively(29/31).Conclusion The false negative rate of sentinel lymph node biopsy in the patients with positive axillary lymph nodes downstage to node negative after neoadjuvant chemotherapy was higher and accuracy rate was lower than 90%.Sentinel lymph node biopsy could not replace axillary lymph node dissection in these patients after neoadjuvant chemotherapy.The sentinel lymph node biopsy can accurately evaluate the axillary lymph node status when using double tracing and taking out 3 or more sentinel lymph node. |
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