【摘要】：1、前哨淋巴結(jié)活檢術(shù)的假陰性分析目的:隊列分析不同示蹤方法在乳腺浸潤性導管癌前哨淋巴結(jié)探查活檢中的假陰性,進一步探究影響假陰性的相關(guān)因素。方法:收集2010年到2016年我中心行前哨活檢術(shù)并行腋窩淋巴結(jié)清掃術(shù)的患者588例,分析不同示蹤方法的效果,比較假陰性率,并分析年齡、分期、分子分型及是否新輔助化療等因素對乳腺癌前哨淋巴結(jié)活檢假陰性的影響。結(jié)果:4種示蹤方法中,乳腺癌前哨淋巴結(jié)假陰性共計50例,其中美蘭染料組假陰性率11.0%,核素+美蘭染料組假陰性6.1%,美蘭染料+熒光組假陰性10%,前3種示蹤方法檢測乳腺癌前哨的假陰性率無統(tǒng)計學差別(P=0.2130.05);美蘭染料+核素+熒光組假陰性為0%。針對所有假陰性患者,分析其與年齡、分子分型的關(guān)系,P值分別為0.879、0.580;分級及是否行輔助化療后檢測乳腺癌前哨的假陰性率結(jié)果間存在統(tǒng)計學意義,P㩳0.05。結(jié)論:不同示蹤方法的假陰性無統(tǒng)計學差異,但染料+熒光假陰性比例較低,且無放射污染,適于全面推廣,故推薦使用染料+熒光法示蹤。美蘭染料+核素+熒光組病例數(shù)較少,需要進一步擴大病例研究。進一步分析發(fā)現(xiàn)分級及是否進行輔助化療的檢測結(jié)果間存在統(tǒng)計學差異(P0.05),即T2組假陰性率明顯高于T1組;前哨淋巴結(jié)活檢術(shù)前行新輔助化療的患者的假陰性比例較高,前哨淋巴結(jié)活檢術(shù)前未行新輔助化療的患者假陰性比例較低,其臨床意義有待進一步研究。年齡和分子分型之間的檢測結(jié)果間無統(tǒng)計學差異(P0.05)。2、乳腺浸潤性導管癌患者1~2枚前哨淋巴結(jié)陽性時非前哨淋巴結(jié)狀況分析目的:前瞻性研究乳腺浸潤性導管癌1~2枚SLN陽性的者NSLN轉(zhuǎn)移狀況。方法:研究納入2010年1月至2015年10月于第三軍醫(yī)大學西南醫(yī)院乳腺外科的乳腺浸潤性導管癌共220例,SLNB確診為1~2枚SLN轉(zhuǎn)移,均行乳腺癌改良根治術(shù),術(shù)后病理分析NSLN的轉(zhuǎn)移情況。同時分析乳腺癌原發(fā)灶分級、分子亞型、是否行新輔助化療及ER、PR、HER-2、Ki67與NSLN轉(zhuǎn)移的關(guān)系。計量資料用c2檢驗,分析年齡與NSLN轉(zhuǎn)移的關(guān)系用非參數(shù)檢驗。結(jié)果:220例乳腺浸潤性導管癌行ALND后非前哨淋巴結(jié)(NSLN)陽性91例,占41.4%(91/220),其中90例均為腋窩Ⅰ水平淋巴結(jié)轉(zhuǎn)移,僅1例同時有Ⅰ、Ⅱ水平淋巴結(jié)轉(zhuǎn)移;NSLN陰性者129例,占58.6%(129/220)。原發(fā)灶分級、分子分型、是否新輔助化療、ER、PR、Ki67表達及年齡等指標對NSLN轉(zhuǎn)移的影響,差異無統(tǒng)計學意義(c2=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)。57例HER-2陽性患者中,NSLN陽性的患者30例,陽性率為52.6%(30/57);在163例HER-2陰性患者中,NSLN陽性的患者61例,陽性率僅為37.4%(61/163)。HER-2陽性患者中NSLN陽性率明顯高于HER-2陰性患者(c2=4.027,P=0.045)。結(jié)論:1~2枚SLN陽性的乳腺浸潤性導管癌患者,其NSLN仍然存在較高的轉(zhuǎn)移風險,尤其在HER-2陽性的患者中更易出現(xiàn)NSLN轉(zhuǎn)移。故1-2枚SLN陽性的乳腺癌患者仍需接受進一步腋窩淋巴結(jié)清掃等治療。3、乳腺癌轉(zhuǎn)移淋巴結(jié)新輔助化療反應及相關(guān)因素探討目的:隊列分析乳腺癌轉(zhuǎn)移淋巴結(jié)新輔助化療后化療反應,探討影響其化療反應的相關(guān)因素。方法:本研究納入2012年-2016年我中心收治病例中臨床查體及影像學檢查提示腋窩淋巴結(jié)轉(zhuǎn)移可能的患者64例,其中女性63例,男性1例。除原發(fā)灶病理活檢外,行超聲引導下腋窩淋巴結(jié)穿刺病理學檢查以確診為乳腺癌轉(zhuǎn)移性淋巴結(jié),其中61例使用粗針穿刺,2例使用麥默通旋切活檢,1例為外院手術(shù)并化療后來我院行機器人輔助內(nèi)乳淋巴鏈切除術(shù)。對確診為乳腺癌淋巴結(jié)轉(zhuǎn)移者行新輔助化療后,病理學評價轉(zhuǎn)移淋巴結(jié)的化療反應。參考2015年《乳腺癌新輔助化療后的病理診斷專家共識》,建立乳腺癌轉(zhuǎn)移淋巴結(jié)新輔助化療反應評價標準。結(jié)果:63例乳腺癌經(jīng)新輔助化療后乳腺癌化療反應情況:原發(fā)灶化療反應I級2例,淋巴結(jié)全為有反應,未轉(zhuǎn)陰。原發(fā)灶化療反應II級12例,其中9例淋巴結(jié)為有反應,未轉(zhuǎn)陰;2例淋巴結(jié)為無反應,未轉(zhuǎn)陰;1例淋巴結(jié)為有反應,已轉(zhuǎn)陰。原發(fā)灶化療反應III級19例,其中14例淋巴結(jié)為有反應,未轉(zhuǎn)陰;1例淋巴結(jié)為無反應,未轉(zhuǎn)陰;3例淋巴結(jié)為有反應,已轉(zhuǎn)陰;1例淋巴結(jié)為無反應,已轉(zhuǎn)陰。原發(fā)灶化療反應IV級18例,其中8例淋巴結(jié)為有反應,未轉(zhuǎn)陰;1例淋巴結(jié)為無反應,未轉(zhuǎn)陰;5例淋巴結(jié)為有反應,已轉(zhuǎn)陰;4例淋巴結(jié)為無反應,已轉(zhuǎn)陰。原發(fā)灶化療反應V級12例,其中3例淋巴結(jié)為有反應,未轉(zhuǎn)陰;6例淋巴結(jié)為有反應,已轉(zhuǎn)陰;3例淋巴結(jié)為無反應,已轉(zhuǎn)陰。經(jīng)新輔助化療后,原發(fā)病灶化療后反應與轉(zhuǎn)移淋巴結(jié)化療后反應并不一致。64例經(jīng)化療后原發(fā)灶達到化療反應V級12例中有3例患者經(jīng)新輔助化療后淋巴結(jié)未轉(zhuǎn)陰,原發(fā)灶未達到化療反應V級51例中有14例患者經(jīng)新輔助化療后淋巴結(jié)轉(zhuǎn)陰。結(jié)論:本研究建立了乳腺浸潤性導管癌轉(zhuǎn)移淋巴結(jié)新輔助化療反應的評價分類方法,能夠?qū)θ橄侔┝馨徒Y(jié)轉(zhuǎn)移病灶化療后反應和緩解進行評價。其臨床意義有待進一步深入研究。新輔助化療對轉(zhuǎn)移淋巴結(jié)療效與原發(fā)灶療效并非完全一致,Luminal A乳腺癌病例新輔助化療后淋巴結(jié)轉(zhuǎn)陰的比例為0。三陰性乳腺癌病例新輔助化療后淋巴結(jié)轉(zhuǎn)陰比例達到75%,轉(zhuǎn)移淋巴結(jié)內(nèi)癌灶未達到完全緩解的其他淋巴結(jié)中均可見化療反應。
[Abstract]:1, the false negative analysis of sentinel lymph node biopsy: a cohort analysis of different tracers in the false negative of sentinel lymph node biopsy in invasive ductal carcinoma of the breast, and further explore the related factors affecting false negative. Methods: 588 cases of the sentinel biopsy and axillary lymph node dissection were collected from 2010 to 2016. We analyzed the effect of different tracer methods, compared the false negative rate, and analyzed the effect of age, staging, molecular typing and new adjuvant chemotherapy on the false negative of sentinel lymph node biopsy in breast cancer. Results: among the 4 tracer methods, 50 cases of false negative negative lymph nodes of the sentinel lymph nodes in the breast cancer, of which the false negative rate of the methylene blue dye group was 11%, and the nuclide + Meilan was used in the methylene blue dye group. The false negative of the dyestuff group was 6.1%, the methylene blue dye + fluorescence group was false negative 10%. The false negative rate of the first 3 tracers was not statistically different (P=0.2130.05); the false negative of the methylene blue dye + nuclide + fluorescence group was 0%. against all the false negative patients, and the relationship between the age and sub typing was analyzed, the P value was 0.879,0.580, classification and whether or not. There was statistical significance between the false negative rates of detecting breast cancer sentinel after adjuvant chemotherapy. P? 0.05. conclusion: there is no statistical difference in the false negative of different tracer methods, but the ratio of the false negative of the dye + fluorescence is low, and there is no radiation pollution, it is suitable for the comprehensive promotion. Therefore, it is recommended to use the dye + fluorescence method. Further analysis was needed to further expand the case study. Further analysis found that there was a statistical difference between the classification and the results of the adjuvant chemotherapy (P0.05), that is, the false negative rate in the T2 group was significantly higher than that in the T1 group; the false negative proportion of the patients with the sentinel lymph node biopsy before the neoadjuvant chemotherapy was higher and the sentinel lymph node biopsy was not new before the biopsy. The false negative proportion of patients with adjuvant chemotherapy is low, and the clinical significance needs further study. There is no statistical difference between the results of age and molecular typing (P0.05).2. The non sentinel lymph node status analysis of 1~2 sentinel lymph nodes in patients with invasive ductal carcinoma of the breast: a prospective study of 1~2 SLN in invasive ductal carcinoma of the breast Methods: 220 cases of invasive ductal carcinoma of breast in the breast surgery of Southwest Hospital of Third Military Medical University from January 2010 to October 2015 were included in 220 cases. SLNB was diagnosed as 1~2 SLN metastasis. All of them were treated with modified radical mastectomy, postoperative pathological analysis of NSLN metastasis. Subtype, the relationship between neoadjuvant chemotherapy and ER, PR, HER-2, Ki67 and NSLN metastasis. Measurement data using C2 test, analysis of the relationship between age and NSLN metastasis by nonparametric test. Results: 220 cases of invasive ductal carcinoma of the mammary gland were 91 cases of non sentinel lymph node (NSLN) positive after ALND, accounting for 41.4% (91/220), of which 90 cases were all axillary I level lymph node metastasis, Only 1 cases had level I, II level lymph node metastasis, 129 cases of NSLN negative, 58.6% (129/220). The effects of primary lesion classification, molecular typing, neoadjuvant chemotherapy, ER, PR, Ki67 expression and age on NSLN metastasis were not statistically significant (c2= 1.830,1.336,0.918,0.074,0.000,1.766, Z=-1.369; P=0.608,0.248,0.338,0.786,0.986,0.1). 84,0.171) in.57 cases with HER-2 positive, 30 cases of NSLN positive were positive, the positive rate was 52.6% (30/57); in 163 cases of HER-2 negative patients, 61 cases were positive for NSLN, and the positive rate was only 37.4% (61/163) in.HER-2 positive patients. The positive rate of NSLN was significantly higher than that of HER-2 negative patients. In cancer patients, NSLN still has a high risk of metastasis, especially in patients with HER-2 positive. NSLN metastasis is more likely to occur in patients with positive HER-2. Therefore, 1-2 SLN positive breast cancer patients still need further axillary lymph node dissection to treat.3, breast cancer metastatic lymph node neoadjuvant chemotherapy and related factors: cohort analysis of breast cancer metastasis Methods: This study included 64 cases of axillary lymph node metastases in 64 cases, including 63 women and 1 male cases, which were diagnosed by clinical examination and imaging examination in -2016 2012. The pathological examination of the nest lymph node puncture was used to diagnose the metastatic lymph nodes of breast cancer, of which 61 cases were treated with rough needle puncture, 2 with maimoral circumflex biopsy, 1 for external hospital surgery and after chemotherapy by robot assisted internal mammary lymphadenectomy. After the neoadjuvant chemotherapy for the lymph node metastases of the breast cancer, the pathological evaluation was changed. A new adjuvant chemotherapy evaluation standard for metastatic lymph nodes of breast cancer was established by the consensus of the 2015 "new adjuvant chemotherapy for breast cancer". Results: 63 cases of breast cancer chemotherapy response to breast cancer after neoadjuvant chemotherapy: 2 cases of primary chemotherapy reaction at grade I, the lymph nodes were all reacted and not turned negative. There were 12 cases of primary chemotherapy reaction at grade II, of which 9 lymph nodes were reacted and not turned negative; 2 cases were not reacted and not turned negative; 1 lymph nodes were reacted and turned negative. 19 cases of III grade in primary chemotherapy reaction, 14 lymph nodes were reacted and not turned negative; 1 lymph nodes were not reacted and negative; 3 lymph nodes had reacted and turned negative; 1 cases had turned negative; 1 cases had turned negative; 1 cases had turned negative; 1 cases had turned negative; 1 cases had turned negative; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin; 1 cases had turned Yin The lymph nodes were not reacted and turned negative. 18 cases of primary chemotherapy response to IV grade, 8 cases of lymph nodes were reacted and not turned negative; 1 cases were not reacted, not turned negative; 5 lymph nodes were reacted and turned negative; 4 lymph nodes were negative, 12 cases of primary chemotherapy reaction, 3 cases of lymph nodes were reacted, not turned negative, and 6 cases were lymph nodes. After the neoadjuvant chemotherapy, the primary focus after chemotherapy was not consistent with the metastatic lymph node chemotherapy after chemotherapy. After chemotherapy, the primary focus of the primary focus after chemotherapy in the 3 cases was not consistent with the chemotherapy reaction after chemotherapy. In the 3 cases, 12 of the 12 cases of chemotherapy after chemotherapy, 3 cases of the lymph nodes were not turned negative after the neoadjuvant chemotherapy, and the primary focus did not reach the chemotherapy reaction V. In the 51 cases, 14 patients were treated with neoadjuvant chemotherapy. Conclusion: This study established an evaluation classification method for the neoadjuvant chemotherapy of lymph node metastasis of invasive ductal carcinoma of the breast. It can evaluate the response and remission of breast cancer lymph node metastases after chemotherapy. Its clinical significance needs further study. The curative effect of chemotherapy on metastatic lymph nodes was not exactly the same as that of the primary focus. The proportion of lymph nodes turned negative after neoadjuvant chemotherapy in Luminal A breast cancer cases was 0. three negative breast cancer cases after neoadjuvant chemotherapy, the proportion of lymph nodes turned negative to 75%, and the chemotherapy reaction was found in other lymph nodes that had not reached complete remission in the metastatic lymph nodes.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

【相似文獻】

相關(guān)期刊論文 前10條

1 張曉明,趙安蘭,張達仁,王肇炎 ,黃立中;Ⅲ期可手術(shù)乳腺癌新輔助化療療效分析[J];現(xiàn)代醫(yī)藥衛(wèi)生;2002年04期

2 楊柯君;;什么是新輔助化療[J];上海醫(yī)藥;2012年08期

3 管衛(wèi)華,龍英,郁寶銘;新輔助化療研究進展[J];國外醫(yī)學(腫瘤學分冊);2001年03期

4 高偉生;夢鵬飛;陳剛;;Ⅲ期非小細胞肺癌新輔助化療的研究進展[J];中國醫(yī)學文摘(腫瘤學);2002年04期

5 王懷碧;幾種惡性腫瘤新輔助化療進展[J];重慶醫(yī)學;2003年05期

6 張學憲,梁慶正,吳曉明;新輔助化療治療Ⅲ期非小細胞肺癌62例報告[J];中國肺癌雜志;2003年04期

7 李堅,俞力超,王蓉芳,吳建農(nóng),丁明,張德厚;新輔助化療對Ⅲ期非小細胞肺癌病理改變的作用及預后的影響[J];中國肺癌雜志;2003年05期

8 鄒強;局部進展期乳腺癌的新輔助化療長期效果[J];國外醫(yī)學.外科學分冊;2003年02期

9 王深明,張國淳,吳惠茜,黃雪玲,朱彩霞;新輔助化療對局部進展期乳腺癌的臨床療效以及細胞和血管組織學的影響[J];嶺南現(xiàn)代臨床外科;2003年04期

10 張曉明;Ⅲ期可手術(shù)乳腺癌新輔助化療的近期和遠期效果[J];實用癌癥雜志;2004年03期

相關(guān)會議論文 前10條

1 彭忠民;劉奇;;新輔助化療對Ⅲ期非小細胞肺癌患者預后的影響[A];第四屆中國腫瘤學術(shù)大會暨第五屆海峽兩岸腫瘤學術(shù)會議論文集[C];2006年

2 顧雅佳;馮曉源;邱龍華;彭衛(wèi)軍;楊文濤;費菲;陳燦敏;唐峰;毛健;邵志敏;;磁共振彌散對局部進展期乳腺癌新輔助化療療效評價的初步研究[A];第四屆中國腫瘤學術(shù)大會暨第五屆海峽兩岸腫瘤學術(shù)會議論文集[C];2006年

3 王蓓;傅健飛;洪中武;;104例局部晚期乳癌新輔助化療的臨床觀察[A];腫瘤化學治療新進展學習班資料匯編[C];2007年

4 張秋月;孟化;;新輔助化療與輔助化療在治療可切除的進展期胃癌中的生存分析[A];第9屆全國胃癌學術(shù)會議暨第二屆陽光長城腫瘤學術(shù)會議論文匯編[C];2014年

5 鄭建華;;新輔助化療在婦科腫瘤中的應用[A];東北三省第四屆婦產(chǎn)科學術(shù)會議論文匯編[C];2008年

6 馬丁;;宮頸癌新輔助化療[A];中華醫(yī)學會第十次全國婦產(chǎn)科學術(shù)會議婦科腫瘤會場（婦科腫瘤學組、婦科病理學組）論文匯編[C];2012年

7 唐美潔;;老年晚期乳腺癌新輔助化療的臨床護理與探討[A];2011年老年護理安全管理學術(shù)交流會暨高級研修班論文集[C];2011年

8 張文瑩;孫曉文;;1例乳腺癌新輔助化療誘發(fā)糖尿病的術(shù)后護理體會[A];“河南省腫瘤專科護士職業(yè)安全防護及新技術(shù)交流”學術(shù)會論文集[C];2011年

9 莫慶玉;;乳腺癌新輔助化療100例的觀察及護理[A];中華護理學會全國腫瘤護理學術(shù)交流暨專題講座會議論文匯編[C];2010年

10 彭忠民;劉奇;;耐藥相關(guān)基因表達對Ⅲ期非小細胞肺癌新輔助化療的臨床預測[A];第四屆中國腫瘤學術(shù)大會暨第五屆海峽兩岸腫瘤學術(shù)會議論文集[C];2006年

相關(guān)重要報紙文章 前10條

1 余志平;輔助治療和新輔助化療具有重要作用[N];中國醫(yī)藥報;2005年

2 宋奇思;治實體瘤先用新輔助化療[N];健康報;2007年

3 北京同仁醫(yī)院外科主任醫(yī)師 肖暉 李新萍整理;新輔助化療為乳癌患者贏得手術(shù)機會[N];健康報;2009年

4 駐京記者 賈巖;NC動搖NSCLC輔助化療地位[N];醫(yī)藥經(jīng)濟報;2010年

5 崔大濤;新輔助化療——重塑乳腺癌治療模式[N];中國醫(yī)藥報;2004年

6 ;可手術(shù)NSCLC的化療及其爭議[N];中國醫(yī)藥報;2003年

7 李新萍;新輔助化療為晚期乳腺癌患者帶來手術(shù)機會[N];中國醫(yī)藥報;2009年

8 本報記者 崔立新;心理問題 乳腺癌患者不能承受之重[N];中國人口報;2003年

9 趙寶椿;乳腺癌手術(shù)后的康復鍛煉[N];家庭醫(yī)生報;2003年

10 黃馨;乳腺癌術(shù)后手臂常舉抬[N];保健時報;2007年

相關(guān)博士學位論文 前10條

1 金廣超;新輔助化療方案對乳腺癌生物學因子的影響[D];山東大學;2015年

2 張帥;加速分割調(diào)強適形放療在鼻咽癌中的臨床應用與新輔助化療的研究及探討[D];山東大學;2016年

3 朱聞捷;乳腺癌新輔助化療療效相關(guān)因素的探索及療效預測模型的建立[D];北京協(xié)和醫(yī)學院;2016年

4 汪令成;新輔助化療對不同分子亞型晚期乳腺癌的療效和預后的臨床研究[D];武漢大學;2015年

5 梁云;子宮頸癌新輔助化療組織學療效評價及相關(guān)免疫因素的研究[D];浙江大學;2017年

6 孫賽花;動態(tài)增強MRI相關(guān)新技術(shù)預測乳腺癌新輔助化療療效及MRI灌注參數(shù)與乳腺癌分子亞型的相關(guān)性[D];北京協(xié)和醫(yī)學院;2017年

7 榮慶林;乳腺癌新輔助化療和改良根治術(shù)后放療的價值[D];北京協(xié)和醫(yī)學院;2017年

8 徐加菊;新輔助化療對乳腺癌患者激素受體及炎性標志物的影響及其與化療療效的相關(guān)性分析[D];山東大學;2017年

9 李雄;宮頸癌新輔助化療敏感性預測因素分析[D];華中科技大學;2015年

10 陳燦銘;局部晚期乳腺癌新輔助化療的研究[D];復旦大學;2004年

相關(guān)碩士學位論文 前10條

1 莫紅彪;乳腺癌前哨淋巴結(jié)活檢術(shù)假陰性及轉(zhuǎn)移淋巴結(jié)新輔助化療反應的研究[D];第三軍醫(yī)大學;2017年

2 許雨虹;新輔助化療對局部晚期鼻咽癌自適應放療的影響[D];福建醫(yī)科大學;2015年

3 牟怡;ATP-TCA在乳腺癌新輔助化療藥物篩選中的應用[D];遵義醫(yī)學院;2015年

4 劉國棟;乳腺癌新輔助化療XEC與FEC和TEC方案的療效及毒性對比分析[D];廣西醫(yī)科大學;2015年

5 賈巍;乳腺癌ET方案新輔助化療前后分子生物學指標變化的分析[D];河北醫(yī)科大學;2015年

6 桑蝶;Ki67與乳腺癌臨床病理特征及新輔助化療療效的相關(guān)性[D];北京協(xié)和醫(yī)學院;2015年

7 陳萌;乳腺癌新輔助化療前后Ki-67變化的臨床意義[D];河北醫(yī)科大學;2015年

8 陳航航;FOXP3~+Tregs對乳腺癌新輔助化療效果的預測價值[D];鄭州大學;2015年

9 張子敬;乳腺癌新輔助化療的病理學指標及動態(tài)增強核磁共振研究[D];復旦大學;2013年

10 劉海波;乳腺癌新輔助化療后患者對丙泊酚敏感性的研究[D];寧夏醫(yī)科大學;2015年

，

本文編號：2160390