改良扩大根治术和经肋间探查对乳腺癌内乳淋巴结转移的检测

Detection and patterns of internal mammary node metastasis of breast cancer with modified extended radical mastectomy and intercostal exploration

目的:探讨乳腺癌内乳淋巴结(IMN)转移规律和有效检测方法。方法:对肿瘤位于乳房内侧和中央的43例乳腺癌患者,27例行保留胸大小肌的改良扩大根治术,16例行扩大根治术,清除内乳淋巴链,常规病理检查,分析IMN检出率、转移率和转移度。其中18例分离胸大肌和肋间肌,先经肋间探查而后切除部分肋软骨清除IMN。结果:lMN检出率93．0％(40／43),转移率46．5％(20／43),转移度38．7％(46／119)。IMN和腋窝淋巴结均有转移者18例,均无转移者17例,IMN阴性、腋窝阳性者6例,IMN阳性、腋窝阴性者2例。临床Ⅰ、Ⅱ和Ⅲ期IMN转移率分别为20．0％(2／10)、38．8％(7／18)和73．3％(11／15)。全组患者均无因IMN清除导致的并发症。18例经肋间探查共发现IMN 31枚,切除肋软骨后清除出IMN 59枚,经病理检查发现IMN 62枚。结论:改良扩大根治术IMN的检出率高,不需要特殊仪器设备,无额外并发症。经肋间IMN活检难以体现实际IMN的状况。

OBJECTIVE：To explove the patterns of internal mammary node （IMN） metastasis of breast cancer and the effective detecting method. METHODS：Extended radical mastectomy and modified extended radical mastectomy were performed in 16 and 27 breast cancer patients with medially located primary tumor, respectively. The internal mammary lymph nodes were excised and examined with HE. stain. The successful rate of IMN detection and the rate of metastasis were analyzed. RESULTS： The successful rate of IMN detection was 93. 0% （40/43） and metastasis occurred in 46.5% cases （20/43）, and the metastatic rate of IMN was 38.7% （46/119）. The status of IMN coincided with that of axillary lymph node in 35 cases. For 6 cases, the IMNs were negative while the axillay lymph nodes were positive and in 2 patients metastasis only occurred in IMN. The metastatic rates of IMN in clinical stage Ⅰ , Ⅱ and Ⅲ were 20.0%（2/10）, 38.8%（7/18） and 73.3%（11/15） respectively. In all the patients, no complications were found as a result of the clearance. CONCLUSIONS： The successful rate of IMN detection is high in modified extended radical mastectomy. IMN clearance can be performed safely and no special equipment is needed.