乳腺癌前哨淋巴结活检的临床应用

Clinical application of sentinel node biopsy in patients with breast cancer

目的评价乳腺癌前哨淋巴结(SLN)预测腋窝淋巴结(ALN)转移的准确性。方法选择我科2007年6月～2008年12月间收治的女性患者60例,所有病例均符合以下条件:(1)原发乳腺单发肿瘤,直径<5cm。(2)临床体检,腋窝淋巴结无肿大。行肿瘤局部切除,送术中冰冻病检为恶性,予美蓝局部注射后行前哨淋巴结活检(SLNB),完成乳腺癌改良根治术。术后根据美国SLNB的评判标准进行评价。结果本组60例病人中有54例成功取到SLN,检出率为90%(54/60)。所有病例均行腋窝淋巴结清扫(ALND)。术后病检结果:SLN和ALN均为阳性者18例;SLN阳性,ALN阴性者4例;SLN阴性,ALN阳性1例;其余31例SLN及ALN均为阴性。根据SLNB的评判标准进行评价,准确率为90.7%,假阴性率为5.3%。结论美蓝注射后行SLNB可以反映ALN的状况。SLNB通过微创手术来了解ALN有无转移,创伤小,并发症少,但用于指导ALND时,必须达到很高的准确性。

Objective To evaluate the accurate rate of predicting axillary node（ALN） metastasis through sentinel node biopsy （SLNB） in the patients with breast cancer. Methods Between 2007 and 2008, 60 female patients with breast cancer were enrolled in The Second Hospital of Yunnan Province. All patients were corresponded with the following conditions： （1） Single tumor of primary breast cancer （diameter〈5cm）; （2） ALN without intumescences by medical examination. These patients were treated by tumor local excision with fast pathology biopsy.Then took sentinel nodes biopsy and the reforming radical operation of breast cancer. We evaluated the predictions based on SLNB Standards （US.）. Results We took sentinel nodes biopsy from the 54 patients in all 60 patients successfully, the detection rate is 90% （54/60）. The results of postoperative pathology biopsy revealed： 18 patients were positive in both SLN and ALN; 4 were positive in SLN, negative in ALN; 1 was positive in ALN, negative in SLN; 31 were negative in both SLN and ALN. The accurate rate was 90.7%, false negative rate was 5.3%. Conclusion Sentinel nodes biopsy can reflect the conditions of axillary nodes in patinents with breast cancer. Even sentinel nodes biopsy is an operation with few complications, but in order to achieve a very high accurate rate, it can be used to guide axillary nodes dissection.