乳腺癌前哨淋巴结活检的临床应用价值(附32例报告)

Lymphatic mapping and sentinel lymph node biopsy in the patients with breast cancer

目的 探讨乳腺癌前哨淋巴结活检技术 (SL NB)的可行性和前哨淋巴结能否准确预测腋淋巴结的状况 ,以指导其在临床中的应用。方法 应用美兰对乳腺癌患者进行前哨淋巴结定位和活检。本组 32例患者于术前10～ 15分钟用美兰液 4 m l注射在肿瘤周围 ,然后先解剖出染色淋巴管 ,追寻到第一站引流淋巴结 (前哨淋巴结 ,SL N) ,单独送病检。之后常规完成乳癌改良根治术或标准根治术。结果 在 32例乳腺癌患者中 ,2 7例检出前 SL N,检出率为 84 .4 %。用美兰定位 SL N预告腋淋巴结转移的敏感率为 80 .0 % ,准确率为 85 .2 % ,特异率为 88.2 % ,假阴性率为 2 0 .0 %。结论 用美兰染色法进行 SL NB能预测腋淋巴结的状态 ,但检出率、准确率仍有待提高。尽管如此 ,该法方便有效 ,临床上仍有推广应用价值。

Objective To identify the feasibility of the lymphatic mapping and sentinel node biopsy(SLNB)in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node(SLN)accurately predict the status of axillary lymph nodes.Methods From Janually 2001 to March 2003,32 patients with breast cancer were evaluated at the Fujian Provincial Hospital.Lymphatic mapping was performed using Methlene Blue.Any blue-stained node was defined as a SLN.Thirty-two patients,with breast cancer underwent a complete axillary lymph node resection(ALNR) after SLN biopsy.Subsequently,all SLNs and ALNs were examined by both H&E staining and immunohistochemical staining for cytokeratin.Results Lymphatic mapping was successful in identifying the SLN in 27/32(84.4%) cases of nodes.The sensitivity of SLNB using Methlene Blue in this study was 80.0%(8/10),accuracy 85.2%(23/27),specificity 88.2%(15/17),and false negative rate 20.0%(2/10).Conclusion SLNB using Methlene Blue can predict the status of the axillary lymph nodes reliably.Although the success rate,the sensitivity and the accuracy of SLNB should be improved,yet the method is used widely in clinical study because of its convinience and efficiency.