美蓝-核素联合法在乳腺癌患者前哨淋巴结活检中的应用

Methylene blue staining conbined with nuclide using in the sentinel lymph node biopsy for patients with breast cancer

目的探讨美蓝-核素联合法在乳腺癌患者前哨淋巴结活检(sentinel lymph node biopsy SLNB)中的临床价值。方法以38例体检无腋窝淋巴结转移的乳腺癌患者为研究对象,在乳晕区注射99mTc标记的硫胶体,采用γ计数器探测仪结合美蓝染色法检测识别前哨淋巴结(sentinel lymph node SLN),先行SLNB,随后行乳腺癌改良根治术。结果38例中2例未见淋巴结及淋巴管蓝染,总计共找到腋窝淋巴结507个,阳性18例131个,阴性20例376个;SLN共71个,阳性17例47个,阴性21例24个。SLN的检出率94.6%,准确性94.4%,特异性100%,敏感性94.4%,假阴性率5.6%,假阳性率0。结论应用美蓝鄄核素联合法前哨淋巴结活检在乳腺癌治疗中可以取得较高的检出率和准确性,可用于确定是否行腋窝淋巴结清扫术。

Objective To explore the clinical value of methylene blue staining combined with nuclide using in the sentinel lymph node biopsy for patients with breast cancer.Methods Thirty three patients without clinical enlargement of axillary lymph nodes were the candidate of this study. Technetium 99m （99mTcDX）labeled colloid were injected in the subareolar of breast.The SLNs were identified by using γ counter combined with methylene blue staining. The sentinel lymph node biopsy was performed before the modified mastectomy.Results In among the 38 patiens, blue-stained lymph nodes or lymphatic vessels were not seen in 2 cases. Total of 507 axillary lymph nodes （histological positive 131 ,negative 376） were found. （histological positive 18 patients,negative 20 patients）.Total of 71 SLN were removed,47 of which were histological positive （17 patients） and ,24 of which were negative （21 patients）.The rates of detection, accuracy, specificity, sensitivity, false negative and the false positive were 94,6%, 94.4%, 100%, 94.4%, 5.6% and zero respectively. Conclusion Methylene blue staining combimed with nuclide using in the sentinel lymph node biopsy of breast cancer patients can acquire high detectable rate and high accuracy.h can be used to decide whether necessity for dissection of ALNs.