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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (11) : 1068 -1074. doi: 10.3877/cma.j.issn.1674-0785.2022.11.007

乳腺癌·临床研究

超声造影联合单染料法前哨淋巴结活检术在初始腋窝淋巴结转移HER2阳性及三阴型乳腺癌中的应用研究
牟鳄贤1, 王浩1, 夏莉1, 李娟2, 曾石岩1, 于淼1, 李俊杰1, 徐佳1, 张蒲蓉1, 卢漫2, 李卉1, 刘世伟1,†()   
  1. 1. 610041　成都，四川省肿瘤医院·研究所，四川省癌症防治中心，电子科技大学医学院乳腺科
    2. 610041　成都，四川省肿瘤医院·研究所，四川省癌症防治中心，电子科技大学医学院超声科
  • 收稿日期:2022-07-16 出版日期:2022-11-15
  • 通信作者: 刘世伟
  • 基金资助:
    成都市科技局技术创新研发项目(2019-YF05-00283-SN); 四川省干部保健科研课题(川干研2021-802)

Contrast-enhanced ultrasonography combined with blue dye for sentinel lymph node biopsy in neoadjuvant-treated HER2-positive or triple-negative breast cancer with initially biopsy-proven nodal metastasis

Exian Mou1, Hao Wang1, Li Xia1, Juan Li2, Shiyan Zeng1, Miao Yu1, Junjie Li1, Jia Xu1, Purong Zhang1, Man Lu2, Hui Li1, Shiwei Liu1,†()   

  1. 1. Department of Breast, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
    2. Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
  • Received:2022-07-16 Published:2022-11-15
  • Corresponding author: Shiwei Liu
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牟鳄贤, 王浩, 夏莉, 李娟, 曾石岩, 于淼, 李俊杰, 徐佳, 张蒲蓉, 卢漫, 李卉, 刘世伟. 超声造影联合单染料法前哨淋巴结活检术在初始腋窝淋巴结转移HER2阳性及三阴型乳腺癌中的应用研究[J]. 中华临床医师杂志(电子版), 2022, 16(11): 1068-1074.

Exian Mou, Hao Wang, Li Xia, Juan Li, Shiyan Zeng, Miao Yu, Junjie Li, Jia Xu, Purong Zhang, Man Lu, Hui Li, Shiwei Liu. Contrast-enhanced ultrasonography combined with blue dye for sentinel lymph node biopsy in neoadjuvant-treated HER2-positive or triple-negative breast cancer with initially biopsy-proven nodal metastasis[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(11): 1068-1074.

目的

纳入初始腋窝淋巴结转移人表皮生长因子受体2（HER2）阳性及三阴性乳腺癌，针对腋窝状态新辅助治疗后临床转阴者，研究超声造影联合单染料法实施前哨淋巴结（SLN）活检术（SLNB）的价值。

方法

研究筛选2020年6月至2022年4月四川省肿瘤医院收治的cT1~3N1M0期HER2阳性及三阴性乳腺癌患者，针对经标准新辅助治疗后腋窝状态临床转阴者，实施超声造影联合单染料法SLNB及补充性腋窝淋巴结清扫。与最终腋窝术后病理转移情况比较，计算超声造影联合单染料法SLNB的SLN检出率、灵敏度、特异度、阳性预测值、阴性预测值、准确性及假阴性率。

结果

共计29例患者纳入研究，中位年龄51岁（28~64岁），24例为HER2阳性，三阴性5例。本研究总体腋窝病理完全缓解率为72.4%（21/29）。所有患者术前超声造影SLN定位均成功，1例患者因术中无蓝染而联合单染料法SLNB失败，SLN检出率96.6%（28/29）。超声造影联合单染料法实施SLNB成功28例，7例腋窝阳性患者均被正确检出，其预测腋窝转移状态的灵敏度、特异度、阳性预测值、阴性预测值、准确性及假阴性率分别为100%（7/7）、100%（21/21）、100%（7/7）、100%（21/21）、100%（28/28）、0%（0/7）。

结论

初始cT1~3N1M0期HER2阳性及三阴性乳腺癌，经标准新辅助治疗后腋窝状态临床转阴者，超声造影联合单染料法SLNB具有理想的SLN检出率及假阴性率，具有进一步研究及临床实践价值。

关键词: 乳腺肿瘤, 三阴性乳腺癌, 超声造影, 前哨淋巴结活检术, 新辅助治疗
Objective

To investigate the significance of sentinel lymph node (SLN) biopsy (SLNB) using contrast-enhanced ultrasonography (CEUS) combined with blue dye in neoadjuvant-treated human epidermal growth factor receptor 2 (HER2)-positive or triple-negative breast cancer with initially biopsy-proven nodal metastasis.

Methods

From June 2020 to April 2022, HER2-positive or triple negative breast cancer patients with baseline stage cT1~3N1M0 and negative axillary status after neoadjuvant therapy were prospectively included at Sichuan Cancer Hospital. All the patients received SLNB and subsequent axillary lymph node dissection. SLNB was conducted using CEUS combined with blue dye. Using the final pathological results as the golden standard, the detection rate, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and false negative rate (FNR) of the combination method were calculated.

Results

Twenty-nine patients were included, with a median age of 51 years (range, 28-64 years); 24 cases were HER2 positive and 5 were triple-negative. The overall rate of axillary pathological complete response was 72.4% (21/29). The detection rate of the combination method was 96.6% (28/29). Twenty-eight patients underwent SLNB successfully using the combination method. Compared with the pathological diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and FNR of the combination method were 100% (7/7), 100% (21/21), 100% (7/7), 100% (21/21), 100% (28/28), and 0% (0/7), respectively.

Conclusion

The combination of CEUS with blue dye for SLNB has a meaningful detection rate and FNR in neoadjuvant-treated HER2-positive or triple-negative breast cancer with initial nodal involvement.

Key words: Breast neoplasms, Triple-negative breast cancer, Contrast-enhanced ultrasonography, Sentinel lymph node biopsy, Neoadjuvant therapy
图1 超声造影腋窝前哨淋巴结定位流程路线图注：HER2为人类表皮生长因子受体2
表1 超声造影SLN增强特点与超声造影联合单染料法SLNB预测腋窝淋巴结转移状态
评估方式 灵敏度 特异度 阳性预测值 阴性预测值 准确性 假阴性率
超声造影（n=29） 5/8 18/21 5/8 18/21 79.3%（23/29） 37.5%（3/8）
超声造影联合单染料法（n=28） 7/7 21/21 7/7 21/21 100%（28/28） 0%（0/7）
图2 前哨淋巴结超声造影定位　A：二维模式下前哨淋巴结；B：超声造影下显示前哨淋巴结；C：体表标记淋巴管及前哨淋巴结
图3 超声造影联合单染料法实施前哨淋巴结活检
1
中华医学会外科学分会乳腺外科学组. 中国早期乳腺癌前哨淋巴结活检手术临床实践指南(2022版) [J]. 中国实用外科杂志, 2022, 42(2): 137-145.
2
Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial [J]. JAMA, 2013, 310(14): 1455-1461.
3
Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study [J]. Lancet Oncol, 2013, 14(7): 609-618.
4
Hu Z, Cheng X, Li J, et al. Preliminary study of real-time three-dimensional contrast-enhanced ultrasound of sentinel lymph nodes in breast cancer [J]. Eur Radiol, 2020, 30(3): 1426-1435.
5
Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual [M]. 8th ed. New York: Springer, 2016: 589-628.
6
Xie F, Zhang D, Cheng L, et al. Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer [J]. World J Surg Oncol, 2015, 13: 319.
7
Hammond ME, Hayes DF, Wolff AC, et al. American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer [J]. J Oncol Pract, 2010, 6(4): 195-197.
8
Wolff AC, Hammond M, Allison KH, et al. Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update [J]. J Clin Oncol, 2018, 36(20): 2105-2122.
9
Elston CW, Ellis IO. Pathological prognostic factors in breast cancer.I.The value of histological grade in breast cancer:experience from a large study with long-term follow-up [J]. Histopathology, 2002, 41(3A): 154-161.
10
Ogston KN, Miller ID, Payne S, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival [J]. Breast, 2003, 12(5): 320-327.
11
Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis [J]. Lancet, 2014, 384(9938): 164-172.
12
Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer [J]. Ann Surg, 1994, 220(3): 391-398; discussion 398-401.
13
Veronesi U, Paganelli G, Viale G, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study [J]. Lancet Oncol, 2006, 7(12): 983-990.
14
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial [J]. Lancet Oncol, 2010, 11(10): 927-933.
15
Li J, Lu M, Cheng X, et al. How pre-operative sentinel lymph node contrast-enhanced ultrasound helps intra-operative sentinel lymph node biopsy in breast cancer: initial experience [J]. Ultrasound Med Biol, 2019, 45(8): 1865-1873.
16
Mougalian SS, Hernandez M, Lei X, et al. Ten-year outcomes of patients with breast cancer with cytologically confirmed axillary lymph node metastases and pathologic complete response after primary systemic chemotherapy [J]. JAMA Oncol, 2016, 2(4): 508-516.
17
甘良雨, 辛灵, 程元甲, 等. 乳腺癌腋窝淋巴结转移患者新辅助化疗后腋窝病理完全缓解的相关因素分析 [J].中华临床医师杂志(电子版), 2021, 15(10): 768-773.
18
Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial [J]. Ann Surg, 2014, 260(4): 608-614; discussion 614-616.
19
Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study [J]. Ann Surg Oncol, 2016, 23(11): 3467-3474.
20
Montagna G, Mamtani A, Knezevic A, et al. Selecting node-positive patients for axillary downstaging with neoadjuvant chemotherapy [J]. Ann Surg Oncol, 2020, 27(11): 4515-4522.
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