染料法乳腺癌前哨淋巴结活检的多因素分析

Multivariate analysis of sentinel lymph node biopsy in breast cancer using blue dye methods

目的:染料法是乳腺癌前哨淋巴结活检的方法之一,其成功率受多种因素影响。本研究旨在探讨影响染料法乳腺癌前哨淋巴结活检成功率的相关因素。方法:2007年1月—2008年8月乳腺癌患者141例,于乳晕周围注射1%亚甲蓝,实施前哨淋巴结活检,随后行腋窝淋巴结清扫,常规HE染色进行病理诊断。采用非条件logistic回归进行单因素和多因素分析。结果:126例患者检出前哨淋巴结,15例检测失败。前哨淋巴结活检成功率89.4%,假阴性率为6.82%。单因素分析结果显示,活检成功率与患者年龄、体质量指数(body mass index,BMI)、肿瘤大小、术前腋窝淋巴结状态、肿瘤分级及腋窝淋巴结阳性数≥4枚显著相关。多因素分析结果显示,年龄(OR=4.587,P=0.024)、BMI(OR=4.882,P=0.011)及腋窝淋巴结阳性数≥4枚(OR=3.143,P=0.013)是前哨淋巴结活检成功率的独立影响因素。结论:亚甲蓝示踪法是乳腺癌前哨淋巴结活检的可靠方法,其成功率与患者年龄、BMI和腋窝淋巴结转移数相关。

Objective： Blue dye was one of the methods for sentinel lymph node biopsy in breast cancer, but the success rate was affected by multiple factors. This study was to determine the related factors contributing to the success of sentinel lymph node biopsy in breast cancer using blue dye method. Method ： From Jan. 2007 to Aug. 2008, sentinel lymph node biopsy was performed by periareo-larly injecting 1% methylene blue in 141 breast cancer patients followed by axillary clearance. Pathological diagnosis was performed for all of the lymph nodes by conventional HE staining. Unconditional logistic regression was applied to make both univariate and multiva- riate analysis. Results：Sentinel lymph node was successfully detected in 126 patients. But the biopsy was failed in the 15 patients. The success rate was 89.4% and the false negative rate was 6.82%. Univariate analysis showed that success rate of biopsy was in association with patients＇ age, body mass index （BMI）, tumor size, preoperative axillary node＇ s status, pathological grade as well as ≥4 positive axillary lymph nodes involved. Multivariate analysis indicated that the patients＇ age （OR=4.587, P=0.024）, BMI （OR=4.882, P=0.011） as well as 4 or more of the axillary nodes involved （OR=3.143, P=0.013） were independent predicting factors for the success of sentinel lymph node biopsy. Conclusious：Methylene blue dyeing is a reliable method for sentinel lymph node biopsy. The rate of success is associated with patients＇ age, BMI as well as the number of metastases in axillary lymph nodes.