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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (03) : 148 -151. doi: 10.3877/cma.j.issn.1674-0807.2017.03.005

论著

1 ～2 枚前哨淋巴结阳性乳腺浸润性导管癌患者非前哨淋巴结状况分析
莫红彪1, 张毅1, 姜军1,†()   
  1. 1.400038 重庆,第三军医大学西南医院乳腺外科
  • 收稿日期:2017-03-23 出版日期:2017-06-01
  • 通信作者: 姜军

Non-sentinel lymph node metastasis in breast invasive ductal carcinoma patients with 1-2 positive sentinel lymph nodes

Hongbiao Mo1, Yi Zhang1, Jun Jiang1,†()   

  1. 1.Department of Breast Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
  • Received:2017-03-23 Published:2017-06-01
  • Corresponding author: Jun Jiang
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莫红彪, 张毅, 姜军. 1 ～2 枚前哨淋巴结阳性乳腺浸润性导管癌患者非前哨淋巴结状况分析[J/OL]. 中华乳腺病杂志(电子版), 2017, 11(03): 148-151.

Hongbiao Mo, Yi Zhang, Jun Jiang. Non-sentinel lymph node metastasis in breast invasive ductal carcinoma patients with 1-2 positive sentinel lymph nodes[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2017, 11(03): 148-151.

目的

分析有1 ～2 枚前哨淋巴结(SLN)阳性的乳腺癌患者的非前哨淋巴结(NSLN)状况。

方法

本前瞻性研究纳入2010 年1 月到2015 年10 月第三军医大学西南医院乳腺外科收治的乳腺浸润性导管癌220 例, 行前哨淋巴结活组织检查(SLNB)证实1 ～2 枚SLN 阳性后均行乳腺癌改良根治术。 术后病理分析NSLN 的情况。 分析患者分子分型、原发灶分级、是否行新辅助化疗及ER、PR、HER-2、Ki67 表达与NSLN 阳性的关系用χ2 检验, 分析年龄与NSLN 阳性的关系用非参数检验。

结果

NSLN 阳性91 例,占41.4%(91/220),其中90 例为腋窝Ⅰ水平淋巴结阳性,仅1 例同时有Ⅰ、Ⅱ水平淋巴结阳性; NSLN 阴性129 例,占58.6% (129/220)。 患者的分子分型、原发灶分级、是否新辅助化疗、ER、PR、Ki67 表达及年龄与NSLN 阳性无关(χ2 =1.830、1.336、0.918、0.074、0.000、1.766,Z=-1.369; P=0.608、0.248、0.338、0.786、0.986、0.184、0.171)。 在57 例HER-2 阳性患者中,NSLN 阳性30 例,阳性率为52.6%;在163 例HER-2 阴性患者中,NSLN 阳性61 例,阳性率为37.4%。 HER-2 阳性患者的NSLN 阳性率高于HER-2 阴性患者(χ2=4.027,P=0.045)。

结论

1 ～2 枚SLN 阳性的乳腺浸润性导管癌患者仍然存在较高的NSLN 阳性风险,尤其HER-2 阳性的患者更易出现NSLN 阳性。

关键词: 乳腺肿瘤, 癌, 导管, 乳腺, 前哨淋巴结活组织检查, 乳房切除术, 改良根治性

Objective

To analyze the metastasis of non-sentinel lymph node (NSLN) in breast invasive ductal carcinoma patients with 1-2 positive sentinel lymph nodes(SLNs).

Methods

A total of 220 patients with breast invasive ductal carcinoma in the Department of Breast Surgery, Southwest Hospital,Third Military Medical University from January 2010 to October 2015 were enrolled in this prospective study.All patients underwent sentinel lymph node biospy (SLNB), which confirmed the metastases of 1 to 2 SLNs,and then they underwent radical mastectomy. NSLN metastases were pathologically analyzed after operation.The relationship between NSLN metastases and molecular subtypes, staging of primary lesions, neoadjuvant chemotherapy, ER, PR, HER-2 and Ki67 expression was analyzed by χ2 test. The relationship between NSLN metastases and patients' age was analyzed by nonparametric test.

Results

Totally 91 cases (91.4%,91/220)had positive NSLN, of which 90 cases had axillary lymph node metastasis in level Ⅰ, and only 1 case had axillary lymph node metastasis in both level Ⅰand Ⅱ. A total of 129 cases were NSLN negative,accounting for 58.6% (129/220). The molecular subtypes, staging of primary lesions, neoadjuvant chemotherapy, ER, PR and Ki67 expression and patient's age showed no significant effect on NSLN metastasis (χ2 =1.830,1.336,0.918,0.074,0.000, 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 NSLN positive, with the positive rate of 52.6%. In 163 HER-2 negative patients,61 were NSLN positive, with the positive rate of 37.4%. The positive rate of NSLN in HER-2 positive patients was significantly higher than that in HER-2 negative patients (χ2 =4.027, P=0.045).

Conclusion

The breast invasive ductal carcinoma patients with 1 to 2 positive SLNs are in high risk of NSLN metastasis, especially in patients with HER-2 positive.

Key words: Breast neoplasms, Carcinoma, ductal, breast, Sentinel lymph node biopsy, Mastectomy, modified radical
图1 乳腺浸润性导管癌患者的蓝染前哨淋巴结
图2 乳腺浸润性导管癌患者的荧光前哨淋巴结
图3 乳腺浸润性导管癌患者术后病理检查显示非前哨淋巴结阳性(HE ×400)
表1 220 例乳腺浸润性导管癌患者临床病理特征与非前哨淋巴结状况的关系
临床病理特征 例数 非前哨淋巴结(例) 检验值 P值
阳性 阴性
分子分型
luminal A 68 31 37 χ2=1.830 0.608
luminal B 109 43 66
HER-2过表达 21 10 11
三阴性 22 7 15
原发灶分级
T1期 82 38 44 χ2=1.336 0.248
T2期 138 53 85
年龄
＜35岁 20 8 12 Z=-1.369 0.171
35～50岁 143 65 78
＞50岁 57 18 39
新辅助化疗
是 44 21 23 χ2=0.918 0.338
否 176 70 106
ER
阳性 177 74 103 χ2=0.074 0.786
阴性 43 17 26
PR
阳性 157 65 92 χ2=0.000 0.986
阴性 63 26 37
HER-2
阳性 57 30 27 χ2=4.027 0.045
阴性 163 61 102
Ki67
≥14% 130 49 81 χ2=1.766 0.184
＜14% 90 42 48
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