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Abstract：
BACKGROUND: Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for assessing axillary lymph node status in clinically node-negative breast cancer patients. However, the approach to axillary surgery after neoadjuvant treatment is still controversial. In the present study, our objective was to predict the pathological nodal stage based on SLNB results and the clinicopathological characteristics of patients who initially presented with clinical N1 positivity but whose disease status was converted to clinical N0 after neoadjuvant chemotherapy (NAC).
METHODS: After NAC, 150 clinically node-negative patients were included. The relationships between clinicopathologic parameters and the number of positive lymph nodes in SLNBs and ALNDs were assessed through binary/multivariate logistic regression analysis.
RESULTS: Among 150 patients, 78 patients had negative SLNBs, and 72 patients had positive SLNBs. According to the ALND data of 21 patients with SLNB1+, there was no additional node involvement (80.8%), 1-2 lymph nodes were positive in 5 patients (19.2%), and no patient had ≥ 3 lymph nodes involved. Following the detection of SLNB1 + positivity, the rate of negative non-sentinel nodes were 75% in the luminal A/B subgroup, 100% in the HER-2-positive subgroup, and 100% in the triple-negative subgroup. Patients with a lower T stage (T1-3 vs. T4), fewer than 4 clinical nodes before NAC (< 4 vs. ≥4), and a decreased postoperative Ki-67 index (< 10% vs. stable/increase) were included. According to both univariate and multivariate analyses, being in the triple-negative or HER2-positive subgroup, compared to the luminal A/B subgroup (luminal A/B vs. HER2-positive/triple-negative), was found to be predictive of complete lymph node response.
CONCLUSIONS: The number of SLNB-positive nodes, tumor-related parameters, and response to treatment may predict no additional nodes to be positive at ALND.
METHODS: After NAC, 150 clinically node-negative patients were included. The relationships between clinicopathologic parameters and the number of positive lymph nodes in SLNBs and ALNDs were assessed through binary/multivariate logistic regression analysis.
RESULTS: Among 150 patients, 78 patients had negative SLNBs, and 72 patients had positive SLNBs. According to the ALND data of 21 patients with SLNB1+, there was no additional node involvement (80.8%), 1-2 lymph nodes were positive in 5 patients (19.2%), and no patient had ≥ 3 lymph nodes involved. Following the detection of SLNB1 + positivity, the rate of negative non-sentinel nodes were 75% in the luminal A/B subgroup, 100% in the HER-2-positive subgroup, and 100% in the triple-negative subgroup. Patients with a lower T stage (T1-3 vs. T4), fewer than 4 clinical nodes before NAC (< 4 vs. ≥4), and a decreased postoperative Ki-67 index (< 10% vs. stable/increase) were included. According to both univariate and multivariate analyses, being in the triple-negative or HER2-positive subgroup, compared to the luminal A/B subgroup (luminal A/B vs. HER2-positive/triple-negative), was found to be predictive of complete lymph node response.
CONCLUSIONS: The number of SLNB-positive nodes, tumor-related parameters, and response to treatment may predict no additional nodes to be positive at ALND.
摘要：
背景：前哨淋巴结活检（SLNB）已取代腋窝淋巴结清扫术（ALND），用于评估临床淋巴结阴性乳腺癌患者的腋窝淋巴结状态。然而,新辅助治疗后腋窝手术的方法仍存在争议.在本研究中,我们的目的是根据SLNB结果和临床病理特征预测病理淋巴结分期,这些患者最初表现为临床N1阳性,但在新辅助化疗(NAC)后病情转变为临床N0.
方法：在NAC之后，包括150例临床淋巴结阴性患者。通过二元/多变量逻辑回归分析评估临床病理参数与SLNBs和ALNDs中阳性淋巴结数量之间的关系。
结果：在150名患者中，78例患者SLNBs阴性，72例患者SLNBs阳性。根据21例SLNB1+患者的ALND数据，没有额外的节点参与(80.8%)，5例（19.2%）淋巴结阳性，并且没有患者有≥3个淋巴结受累。在检测到SLNB1+阳性后，管腔A/B亚组的非前哨淋巴结阴性率为75％，HER-2阳性亚组100%,和100%在三阴性亚组。T分期较低的患者（T1-3vs.T4),NAC前少于4个临床节点(<4vs.≥4),术后Ki-67指数降低(<10%vs.稳定/增加)包括在内。根据单变量和多变量分析，处于三阴性或HER2阳性亚组，与腔内A/B亚组(腔内A/Bvs.HER2阳性/三阴性)，被发现是完全淋巴结反应的预测。
结论：SLNB阳性节点的数量，肿瘤相关参数，对治疗的反应可能会预测ALND没有其他节点是阳性的。
方法：在NAC之后，包括150例临床淋巴结阴性患者。通过二元/多变量逻辑回归分析评估临床病理参数与SLNBs和ALNDs中阳性淋巴结数量之间的关系。
结果：在150名患者中，78例患者SLNBs阴性，72例患者SLNBs阳性。根据21例SLNB1+患者的ALND数据，没有额外的节点参与(80.8%)，5例（19.2%）淋巴结阳性，并且没有患者有≥3个淋巴结受累。在检测到SLNB1+阳性后，管腔A/B亚组的非前哨淋巴结阴性率为75％，HER-2阳性亚组100%,和100%在三阴性亚组。T分期较低的患者（T1-3vs.T4),NAC前少于4个临床节点(<4vs.≥4),术后Ki-67指数降低(<10%vs.稳定/增加)包括在内。根据单变量和多变量分析，处于三阴性或HER2阳性亚组，与腔内A/B亚组(腔内A/Bvs.HER2阳性/三阴性)，被发现是完全淋巴结反应的预测。
结论：SLNB阳性节点的数量，肿瘤相关参数，对治疗的反应可能会预测ALND没有其他节点是阳性的。
