前哨淋巴结活检术在早期乳腺癌保腋窝治疗中的应用

Clinical study of axillary conservative surgery by sentonel lymph node biopsy in early stage breast cancer

目的:探讨乳腺癌前哨淋巴结活检术(sentonel lymph node biopsy,SLNB)对SLN阴性者进行保腋窝的可行性。方法:联合应用专利蓝(patent blue-v)和99mTc标记的硫胶体(99mTc-Sulphur colloid,99mTc-Sc)行乳腺癌前哨淋巴结活检术。对SLN阴性并同意保腋窝者免除腋窝淋巴结清扫(axillary lymph node dissection,ALND),对SLN阳性或虽SLN阴性但不同意保腋窝者仍行ALND。结果:2002年3月～2006年3月入组临床分期T1～2N0M0乳腺癌患者135例,均行SLNB。SLN阳性44例,其中42例行ALND,2例镜下有微小转移灶者仅行SLNB术后加腋窝淋巴结区域放疗;SLN阴性91例(67.4%),其中的39例仅行SLNB,52例仍行ALND。全组SLNB准确率97.8%(132/135),假阴性率6.8%(3/44)。全组中位随访43个月(24～72个月),SLNB保腋窝者术后并发症明显低于ALND者(P<0.05),区域淋巴结无复发,ALND者区域淋巴结亦无复发。结论:SLNB保腋窝近期疗效满意具有良好的微创效果。

Objective：To evaluate the possibility of axillary conservative surgery by sentonel lymph node biopsy（SLNB） in early stage breast cancer patients with negative SLNs received SLNB only.Methods：Sentonel lymph nodel（SLN） was detected with the combination of patent blue-v and ^99mTc-Sulphur colloid.The patients with negative SLNs received SLNB only,while those did agreed.The patients with negative SLNs who did not agree with substiring axillary lymph node dissection（ALND） and the patients with positive SLNs received ALND.Results：The clinical study was carried from March 2003 to March 2006.Among the total,135 patients belonged to clinical stage T1-2N0M0 were submitted by SLNB.While 39 of 91 patients with negative SLNs received SLNB only.While 42 of 44 patients with positive SLNs received ALND,and 2 patients with micrometastasis received SLNB plus radiotherapy to the axilla.The accuracy rate and false negative rate of the SLNB cases were 97.8% and 6.8%.All the patients were followed up.With a median follow-up of 43 months（24-72 months）,the complications of the SLNB cases were significantly fewer than the ALND cases（P〈0.05）.Conclusion：Axillary conservative surgery is an appropriate method in short period and postoperative complications in early stage breast cancer patients with negative SLNs.