乳腺癌哨兵淋巴结活检假阴性分析

False negative analysis of sentinel lymph node biopsy in breast carcinoma

目的探讨在哨兵淋巴结(SLN)活检(SLNB)中影响检出成功率的假阴性的相关因素。方法应用原发肿瘤周围注射l%亚甲蓝示踪方法对84例Ⅰ、Ⅱ期原发性乳腺癌患者进行SLNB,随后进行包括腋窝淋巴结清扫(ALND)在内的乳腺癌手术。通过对SLNB中的相关变量分析,确定可以造成SLNB假阴性的因素。结果①肿瘤周围乳房皮下多点注射和4点注射阳性检出率分别为90%、78%,假阴性率分别为6%、8%;②临床因素中年龄、体重指数、肿瘤大小对假阴性的检出有明显意义,而肿瘤位置在假阴性的检出中无明显差别;③病理检测中连续切片(SS)+免疫组化(IHC)同苏木精(HE)染色的假阴性率分别为7%、23%。结论①联合应用染料法及同位素法可使检出率进一步提高。②多点注射可提高检出率。③综合考虑临床因素可降低假阴性的检出。④联合SS+IHC检测较单纯HE染色可明显减少假阴性的检出率。

Objective To validate the related factors of detective successful rate of sentinel lymph node （SLN） biopsy in breast carcinoma. Methods Methods SLNs in breast carcinoma were dyed by 1% methylene blue injected into 81 cases of primary carcinomas. Breast carcinoma surgery involving axillary lymph node dissection （ALND） was conducted later. By related variance analysis, the factors resulting in false negative SLNB were determined. Results ①The positive detective rates of multipoints and 4 points hypodermic around the tumor of breast were 90% and 78% respectively, false negative rates were 6% and 8% respectively.②The clinical factors such as age, index of weight, the size of tumors were significantly associated with false negative of SLN, the location of tumor were not significant different. ③ Pathological examinations false negative rates in serial section （SS） ＋ immunohistochemistry （IHC） and hematoxylin and eosin （HE） staining were 7% and 23% respectively. Conclusions ①Using SS ＋ IHC methods the positive results could increase; ②muhipoints hypodermic could increase positive results of SLN ;③General analysis of clinical factors could decrease false negative rate ; ④False negative rate of combine using SS ＋ IHC were less than that of HE method.