Background/Objectives: The aim of the study was to determine the clinical value of the sentinel lymph node ratio (SLN-R) in predicting additional positive lymph nodes during axillary lymph node dissection (ALND) in breast cancer patients following neoadjuvant chemotherapy (NAC). Methods: A cross-sectional study was performed at a single institution evaluating data from 1521 BC patients. Inclusion criteria comprised cT1/cT4, cN0/cN1 status with positive post-NAC axillary staging by SLN/TAD, respectively, and subsequent ALND. Results: The study included 118 patients, divided into two groups based on the presence or absence of additional node metastasis at ALND: 39 in the residual disease group (RD) and 79 in the non-residual disease group (nRD). Univariate logistic regression analysis of SLN-R was conducted to assess its predictive value, yielding an odds ratio (OR) of 7.79 (CI 1.92–29.5,p= 0.003). An SLN-R cut-off point of <0.35 was identified using ROC curve analysis, with a false-negative rate of 10.2%, as a predictor for no additional metastasis at ALND following post-NAC SLN/TAD positivity. Conclusions: The study concludes that SLN-R is a valuable predictor for determining the omission of ALND in cases where SLN/TAD is positive after NAC. This metric, in combination with other clinical variables, could help develop a nomogram to spare patients from ALND.
背景/目的：本研究旨在评估前哨淋巴结比率（SLN-R）对预测乳腺癌患者新辅助化疗（NAC）后腋窝淋巴结清扫术（ALND）中额外阳性淋巴结的临床价值。方法：本研究为单中心横断面研究，共纳入1521例乳腺癌患者数据。入组标准包括临床分期cT1-cT4、cN0-cN1，且经新辅助化疗后前哨淋巴结/靶向腋窝淋巴结切除（SLN/TAD）病理证实腋窝淋巴结阳性并后续接受ALND的患者。结果：最终118例患者纳入分析，根据ALND是否发现额外淋巴结转移分为两组：残留病灶组（RD）39例，无残留病灶组（nRD）79例。通过单因素逻辑回归分析评估SLN-R的预测价值，得出比值比（OR）为7.79（95%置信区间1.92-29.5，p=0.003）。受试者工作特征曲线分析确定SLN-R截断值为<0.35，作为预测新辅助化疗后SLN/TAD阳性患者ALND无额外转移的指标，其假阴性率为10.2%。结论：研究表明，SLN-R可作为新辅助化疗后SLN/TAD阳性患者豁免ALND的重要预测指标。该指标结合其他临床变量，有助于构建列线图模型，使部分患者避免不必要的腋窝淋巴结清扫术。
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