乳腺癌前哨淋巴结检测的临床研究

A clinical study on sentinel lymph node biopsy in patients with breast cancer

目的 通过前哨淋巴结 (sentinellymphnode ,SLN)活检 ,了解前哨淋巴结是否能反映乳腺癌腋窝淋巴结转移情况 ,从而决定是否行腋窝淋巴结清扫 (axillarylymphnodedissection ,ALND)。 方法 4 7例T1、T2 、T3 临床检查腋窝淋巴结无肿大的乳腺癌患者 ,术前 30min于乳腺肿块周围腺体注射蓝色染料 ,术中取蓝染的SLN病理检查 ,术后将病理检查结果与腋窝淋巴结转移情况进行比较分析。 结果 4 7例中 5例未见淋巴结及淋巴管蓝染 ,其余 4 2例找到腋窝淋巴结 6 0 8个 ,阳性 18例 16 8个 ,阴性 2 4例 4 4 0个 ;SLN共 78个 ,阳性 16例 2 9个 ,阴性 2 6例 4 9个。SLN的检出率 89 4 % ,准确性 95 2 % ,特异性 10 0 % ,敏感性 88 9% ,假阴性率 11 1% ,假阳性率 0。 结论 SLN活检反应腋窝淋巴结的肿瘤转移状况 。

Objective To evaluate the significance of sentinel lymph node (SLN) biopsy for predicting axillary metastasis in patients with breast cancer,so as to consider whether axillary lymph node dissection (ALND) can be carried out. Methods Forty seven patients with breast cancer in stage T 1 ～ T 3,without clinical enlargement of axillary lymph nodes,entered this study.Methylene blue was injected into the surrounding glands adjacent to the mammary mass 30 min preoperatively,and then the blue-stained SLNs were resected for pathological examination,the findings of which were compared with conditions of axillary metastasis of lymph nodes postoperatively. Results Out of the 47 patients,blue-stained lymph node or lymphatic vessel were not seen in 5 cases,and a total of 608 axillary lymph nodes (histologically positive,168; negative,440) were found in the remaining 42 patients (histologically positive,18 patients; negative,24 patients).A total of 78 SLN were removed,29 of which were histologically positive (16 patients) and 49 of which,negative (26 patients).The detectable rate was 89.4%,the accuracy was 95 2%,the specificity was 100%,the sensitivity was 88 9%,the false-negative rate was 11 1%,and the false-positive rate,0. Conclusions SLN biopsy may predict the metastases of axillary lymph node in patients with breast cancer,and may be used to decide whether ALND is required during the surgery.