前哨淋巴结活检在乳腺癌保乳手术中的应用研究

Detection and clinical significance of sentinel 1ymph nodes biopsy in breast-conserving surgery for breast cancer

目的探讨前哨淋巴结(SLN)活检在乳腺癌保乳手术中的检测方法和临床意义。方法对65例Ⅰ～Ⅱa期乳腺癌患者实行SLN活检并保乳手术联合术后放疗、化疗及内分泌治疗的综合治疗。于术前2～4h在肿瘤下方或瘤床内注射0.4mL/37MBq放射性物质99mTc_DX,术中用r探测仪定位并切除前哨淋巴结,再行乳腺肿瘤切除及腋窝淋巴结清扫。首先对SLN及ALN进行常规HE检测,再行免疫组织化学(1HC)检测及逆转录多聚酶链反应(RT-PCR)检测细胞角蛋白19(CKl9)mRNA的表达以检测淋巴结的微转移。结果65例中均检出SLN,其检出率为100%,共检出SLN136枚,平均2.1枚,SLN的检出灵敏度为96.3%(27/28),准确性98.5%(64/65),特异性为100%(38/38)。保乳手术方式包括肿瘤局部切除+腋窝淋巴结清扫术(AL-ND)16例;象限切除+ALND术49例。平均随访32.5个月,均健在,局部复发1例。结论乳腺癌SLNB是可行的,SLN可以预测ALN的转移情况。早期乳腺癌采用保乳手术加综合治疗可以取得满意的临床疗效,且美容效果良好,可作为早期乳腺癌的首选治疗方法。

[Objective] To study the detection methods and clinical value of sentinel lymph nodes（SLN） biop- sy in the breast-conserving surgery for breast cancer. [Method] 65 cases of breast cancer were treated with breast-conserving surgery （BCS） plus adiotherapy,chemotherapy and hormonotherapy postoperatively. 99mTc_DX particles were disected into the breast tissue adjacent to the primary tumor or resection cavity.After 2-4 hours the SLN identified by gamma detector were dissected out,followed by an axillary lymph node dissection（ALND）.The SLN and ALN were evaluated with histopathology,immunohistochemistry（1HC） and RT-PCR （examined CK19 mRNA）. [Result] The SLNs were identified in 65 patients,altogether 136 SLNs were harvested,an average of 2.1 SLNs was examined. The sensitivity, accuracy, specificity of SLNB in this study was 96.3% ,98.5%, 100% respectively. 49 cases were received quadrant resection plus axillary lymph node dissection（ALND） 16 cases were received local resection plus ALND.All cases were followed up an average of 32.5 months and one case recurred regionally. [Conclusion] Gamma detector probe can be used for SLN detecting in breast cancer patients. SLNB combined with local resection was safe to the breast cancer patients with negative SLN.Breast-conserving surgery plus combined treatments in safe and satisfactory for early breast cancer.It can be considered as the first choice for the treatment of patients with early-stage of breast cancer.