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对于乳腺癌患者，如果进行靶向腋窝清扫（包括切除活检证实阳性淋巴结和前哨淋巴结），可以实现低于10%的假阴性率。不过，对于乳腺癌初始腋窝转移新辅助化疗后患者，靶向腋窝清扫术中印片细胞学检查准确性的证据缺乏。 2018年8月6日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学年鉴》在线发表复旦大学附属肿瘤医院和上海医学院邬思雨、王玉洁、张娜、李剑伟、柳光宇等学者的研究报告，探讨了新辅助化疗后靶向腋窝清扫术中印片细胞学检查的准确性。 该前瞻研究入组活检证实淋巴结转移的乳腺癌患者951例，其中术前（新辅助）化疗92例、术后（辅助）化疗859例。所有患者接受靶向腋窝清扫，术中进行印片细胞学检查，以评估活检证实阳性淋巴结和前哨淋巴结。通过与腋窝淋巴结苏木精伊红染色比较，计算靶向腋窝清扫＋术中印片细胞学检查的准确性。术后6个月内接受辅助化疗患者的术中印片细胞学检查结果作为对照。 结果发现，总体而言，靶向腋窝清扫的假阴性率为10.8%，所有术中印片细胞学检查假阴性都涉及微转移或孤立肿瘤细胞患者。 术中印片细胞学检查的准确度、特异度、灵敏度分别为：
因此，对于活检证实腋窝转移的乳腺癌患者，术前新辅助化疗与术后辅助化疗相比，靶向腋窝清扫术中印片细胞学检查可行，准确度、特异度相似，灵敏度较高。术中印片细胞学检查有助于减少新辅助化疗后腋窝淋巴结残留病变患者的第二次手术量。 Ann Surg Oncol. 2018 Aug 6. [Epub ahead of print] Intraoperative Touch Imprint Cytology in Targeted Axillary Dissection After Neoadjuvant Chemotherapy for Breast Cancer Patients with Initial Axillary Metastasis. Siyu Wu, Yujie Wang, Na Zhang, Jianwei Li, Xiaoli Xu, Juping Shen, Guangyu Liu. Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China. BACKGROUND: For breast cancer patients, a false-negative rate lower than 10% can be achieved if targeted axillary dissection (TAD) is performed, which includes the excision of both biopsy-proven positive lymph nodes (BxLNs) and sentinel lymph nodes (SLNs). However, little evidence exists on the accuracy of intraoperative touch imprint cytology (ITPC) applied in TAD after neoadjuvant chemotherapy (NAC) for breast cancer patients with initial axillary metastasis. This study aimed to investigate the accuracy of ITPC in TAD after NAC. METHODS: Breast cancer patients with biopsy-confirmed nodal metastasis were prospectively enrolled in the study. After completion of NAC, all patients underwent TAD followed by axillary lymph node dissection (ALND). Then ITPC was performed to evaluate BxLNs and SLNs. The accuracy of TAD and ITPC was calculated in comparison with hematoxylin and eosin (H&E) staining of ALNs. The results of ITPC during 6 months at our center in the adjuvant setting were used for comparison . RESULTS: Overall, the false-negative rate of TAD was 10.8%. In a test with 92 patients, ITPC had an accuracy of 92.4%, a sensitivity of 87.9%, and a specificity of 94.9%. In the non-NAC group, ITPC showed similar accuracy (91.2%) and specificity (97.9%) but significantly lower sensitivity (68.9%; P=0.03). CONCLUSIONS: The use of ITPC was feasible for TAD among breast cancer patients with biopsy-confirmed axillary metastasis who were treated with NAC. All the misses in the ITPC involved patients with micrometastases or isolated tumor cells. Use of ITPC can help decrease the number of second operations for patients with residual disease in ALNs after NAC. DOI: 10.1245/s10434-018-6548-9
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