国产亚甲蓝行早期乳腺癌前哨淋巴结活检的观察

The observation of sentinel lymph node biopsy with methylene blue in early breast cancer

目的:探讨前哨淋巴结活检术(sentinellymphnodebiopsy,SLNB)反映早期乳腺癌腋淋巴结转移情况,并指导临床腋淋巴结阴性(cNO)乳腺癌腋窝淋巴结清除范围的可行性。方法:使用国产1%亚甲蓝对120例cT1、2N0M0期乳腺癌病人进行前哨淋巴结活检。于原发肿瘤边缘上、下、左、右选取4个注射点,将1%亚甲蓝4ml分别注射到乳腺实质及皮下组织内,已行术中活检则注射于残腔壁周围及其表面的皮下组织内。注射后从注射点向腋窝方向轻按摩5～10min,以利于淋巴管和淋巴结的染色,随后行乳腺癌改良根治手术或保乳手术。SLN常规HE染色病理检查,阴性者通过免疫组化方法行淋巴结微转移检查。结果:确定SLN87例,成功率为72.50%。SLNB的特异度为100%,假阳性率为0%,假阴性率为1.5%,准确率为98.85%;阴性前哨淋巴结的微转移率为4.44%。结论:前哨淋巴结转移状况基本上可反映乳腺癌腋淋巴结转移的状况;SLNB有望成为指导cNO期乳腺癌腋淋巴结清除范围的方法。

Objective To explore the accuracy of sentinel lymph node biopsy （SLNB） with methylene blue in determining the extent of axillary lymph node （LN） dissection for cN0M0 breast cancer patients. Methods One ml of 1% methylene blue was injected subcantaneously at each of the 4 sites around the tumor or in the walls of the biopsy wound. Biopsy was carried out in 120 patients undergoing SLNB 5-10 minutes after injection of the dye; according to the results of the frozen section, modified axillary LN dissection or breast-conserving operation was decided upon. Results SLN was identified in 89 patients, the successful detection rate was 72.50%（87/120）, the specificity was 100%, and the falsepositive was 0% and the false-negative was 1.5%,the accuracy heing 98.85%. Conclusions The SLN status can generally represent the condition of the axillary metastasis. SLNB is useful to determine whether modified axillary LN dissection in or breast-conserving operation should be carried out.