乳腺癌前哨淋巴结的检测及临床意义

The detection and clinical significance of sentinel lymph node biopsy in breast cancer

目的:探讨乳腺癌前哨淋巴结(SLN)活检及其微转移的检测方法和临床意义。方法:对125例乳腺 癌患者于术前2～4h在肿瘤下方或瘤床内注射0.4ml/37MBq放射性物质99mTc DX,术中用γ探测仪定位并切除前 哨淋巴结,再行乳腺肿瘤切除及腋窝淋巴结清扫。首先对SLN及ALN进行常规HE检测,再行免疫组织化学 (IHC)检测及逆转录多聚酶链反应(RT PCR)检测细胞角蛋白19(CK19)mRNA的表达以检测淋巴结的微转移。 结果:125例中发现116例SLN,其检出率为92.8%(116/125),共检出SLN235枚,平均2.0枚,本组SLN的检出灵 敏度为97.9%(47/48),准确性99.0%(104/105),假阴性率为2.1%(1/48),假阳性率为0。结论:乳腺癌SLNB是 可行的,SLN可以预测ALN的转移情况。SLN阴性的早期乳腺癌仅行局部切除是可行的。

Objective:To study the detection methods of micrometastasis and clinical value of sentinel lymph node(SLN) biopsy in the management of breast cancer. Methods: 99mTc-DX particles were injected into the breast tissue adjacent to the primary tumor or resection cavity. After 2～4 hours the SLN identified by gamma detector were dissected out, followed by an axillary lymph node dissection(ALND). The SLN and ALN were evaluated with histopathology, immunohistochemistry(IHC) and RT-PCR (examined CK19 mRNA). Results:The SLNs were identified in 116 of 125 patients, altogether 235 SLNs were harvested, an average of 2.0 SLNs was examined. The sensitivity, accuracy, false positive, false negative of SLNB in this study was 97.9%, 99.0%, 0%, and 2.1% respectively. Conclusion:Gamma detector probe can be used for SLN detecting in breast cancer patients. SLNB combined with local resection was safe to the breast cancer patients with negative SLN.