腋窝前哨淋巴结所在群切除替代ALND治疗早期乳腺癌的临床研究

Clinical study on treatment for early breast cancer with SLNs group dissection instead of SLNB

目的探讨早期乳腺癌外科腋窝处理的理想方法,明确腋窝前哨淋巴结(SLN)所在淋巴结群切除替代单纯前哨淋巴结活检(SLNB)的假阴性率是否较明显降低,从而为临床应用提供依据。方法采用传统的腋窝淋巴结解剖学分群方法,对170例符合入组条件的病例手术中先行腋窝SLNB,再行SLN所在腋淋巴结群的清扫,最后行全腋窝淋巴结清扫(ALND),对SLN、SLN所在腋淋巴结群的其它淋巴结、腋窝其余的淋巴结分三组送病理检查,比较SLNB与SLN所在淋巴结群切除活检预测腋淋巴结状态的差异。结果SLNB总成功率为99.4%(169/170),SLNB5例假阴性,假阴性率9.6%(5/52),敏感性90.4%(47/52),准确率97.0%(164/169);阳性预测值100.0%,阴性预测值95.9%。SLN所在淋巴结群切除活检预测腋淋巴结状态仅1例假阴性,假阴性率1.9%(1/52),敏感性98.1%(51/52),准确率99.4%(168/169);阳性预测值100.0%(51/51),阴性预测值99.2%(117/118)。结论腋窝SLN所在淋巴结群切除活检预测腋淋巴结状态的假阴性率较单纯SLNB明显降低(P<0.05)。

Objective To investigate the adequate surgical axillary management for early breast cancer,and the falsenegative rate of axillary lymph nodes,which was compared between sentinel lymph nodes biopsy （SLNB） and dissection of sentinel lymph nodes （SLNs） group. Methods Axillary lymph nodes were grouped according to traditional axillary lymph node anatomic grouping. One hundred and seventy patients who recruited into this study underwent axillary SLNB first,then dissection of SLNs group,finally standard axillary treatment at the same operation in all patients. All lymph nodes underwent pathological investigation respectively. Results SLNs were identified in 169 （99.4%） of 170 evaluable cases. There were 5 false negatives,resulting in a false-negative rate of 9.6%（5/52）,a sensitivity of 90.4%（47/52） and an accuracy rate of 97.0% （164/169）. In dissection of SLNs group,there was only one false negative, resulting in a false-negative rate of 1.90% （1/52） ,a sensitivity of 98.1% （51/52） and an accuracy rate of 99.4% （168/169）. Conclusions The false-negative rate in patients who have SLNs harvested is remarkably decreased,compared with those who have SLNs group removed （P〈0.05）.