乳腺癌前哨淋巴结活检的意义

Clinical significance of sentinel lymph node biopsy in breast cancer

目的探讨前哨淋巴结(sentinellymphnode,SLN)是否可以反映腋窝淋巴结状况及该技术在临床中的应用。方法利用99m碍标记的右旋糖酐(99mTc-DX)于1999年5月-2004.年2月进行乳腺癌SLN活检116例,术中用γ探测仪进行定位,SLN活检后行改良根治术或保乳手术,对SLN单独送检并进行详细的病理学检查。结果成功进行SLN活检111例,成功率为96%,每例检出SLN1-4个不等,平均2.4个,所有SLN均位于腋窝第一水平,SLN活检的灵敏度为92%,特异度为100%,假阴性率为8%,假阳性率为0,准确性为96.6%,阳性结果预测值为100%,阴性结果预测值为94.3%,尤登指数为0.92。进行免疫组化染色的26例SLN中,共发现2例微小转移,但2例中非SLN未见微小转移。结论SLN可以反映腋窝淋巴结的转移情况,并可以指导临床决定是否需行腋窝解剖,同位素示踪法进行SLN活检具有操作简单、准确性高等优点。

Objective To study whether the characteristics of the sentinel lymph node(SLN) accurately predict the status of axillary nodes and the application of SLN biopsy in clinical practice. Methods Between May, 1999 and Febrary, 2004, in 116 breast cancer patients, the sentinel lymph nodes identified by 99mTc-DX were excised for biopsy by using a hand-held-γ-detection probe in operation, after SLN biopsy modified mastectomy or breast-conserving therapy was followed. The SLNs were examined separately and in detail by pathologist. Results SLNs were identified in 111 patients, the successful rate was 96%. The number of SLNs in every patient ranged from 1 to 4, and the average number was 2. 4. All SLNs were located at level I of axillary. The sensitivity of SLN biopsy was 92%, the specificity was 100%,the false negative rate was 8%, the false positive rate was 0, the accuracy rate was 97. 2% , the positive predictability was 100%, the negative predictability was 95% , Youden's index was 0. 92. In 2 of 26 cases examined by immunohistochemical staining, micrometastases were found, but were not found in their non-SLNs. Conclusion SLN can evaluate the status of axillary lymph nodes in breast cancer patients and determine whether the axillary dissection is done. The method of SLN identified by isotope has many advantages of simplicity, high accuracy and so on.