前哨淋巴结活检在乳腺癌治疗中的应用

Sentinel Lymph Node Biopsy for Treatment of Breast Cancer

目的探讨前哨淋巴结（sentinel lymphnode，SLN）是否反映腋窝淋巴结状况。方法利用锝99m标记的硫胶体（^99mTc-硫胶体）进行乳腺癌SLN活检34例，术中用r探测仪进行定位，SLN活检后行改良根治术或保乳手术，对SLN单独送检。结果34例SLN成功活检33例，成功率97．06％，每例检出SLN1-3个不等，平均1．26个，SLN活检的灵敏度为94．12％，特异性100％，假阴性率2．93％，假阳性率0，阴性结果预测值为100％，准确性100％。结论SLN可以反映腋窝淋巴结的转移情况，使大多数患者瓣免行腋淋巴结洁扫。

Objective Determination of axillary nodal status is essential for treatment of breast cancer since nodal status is one of the most important predictors of survival. The objective of this study was to test the hypothesis that the histology of the first draining lymph node accurately prediets the histology of the rest of the axillary LNs. Methods 34 patients with operable invasive breast cancer and clinically negative axillary lymph nodes were studied. Patients were injected with Technetium-99 （99m Te） sulfur colloid around the primary tumor. A hand-held gamma detector probe was used to identify the SLN. After the SLN was identified and removed, a level Ⅰ and Ⅱ lymphadeneitomy was performed. Results The SLN was identified in 33 （97.06%） of the 34 patients entered into the trial. The sensitivity was 94.12% and the specificity was 100% . The positive predictive value was 100% and the negative predictive value was 100%. The accuracy of the study was 100%. Conclusion The SLN biopsy for breast cancer staging is highly accurate minimally invasive method of staging patents with breast eaneer and can substantially reduce the morbidity and costs of surgical treatment by avoiding unnecessary ALND in the majority of patients.