应用亚甲蓝行乳腺癌前哨淋巴结活检276例分析

Methylene blue guided sentinel lymph node biopsy in 276 breast cancer patients

目的探讨以亚甲蓝作为示踪剂行乳腺癌前哨淋巴结（SLN）活检的临床应用及影响因素。方法分析了276例临床T1-T2N0M0乳腺癌患者前哨淋巴结活检（SLNB）结果，对SLN检出率及假阴性率影响因素进行了初步分析。结果276例患者中，成功检出SLN者246例（检出率为89．1％）。共检出SLN423枚，每例1～4枚。前哨淋巴结对腋窝淋巴结转移情况预测的敏感性为77．3％（68／88），假阴性率为8．1％（20／246），假阳性率为0，准确率为91．9％（226／246）。临床T2N0M0SLNB成功率高于临床T1N0M0乳腺癌患者（P=0．046）；年龄〈50岁者SLNB检出成功率高于年龄≥50岁病例（P=0．000），SLNB假阴性率年龄〈50岁者显著低于高龄患者（P=0．037）；外上象限和外下象限肿瘤SLNB检出成功率明显高于其他象限（P=0．000）。内上象限肿瘤SLNB假阴性率高于外上及外下象限（P=0．018）。临床TMN分期、ER、PR表达情况及病理类型对SLNB成功率及假阴性率无影响。结论以亚甲蓝作为示踪剂行乳腺癌SLNB，患者年龄、临床TNM分期、肿瘤部位对SLN检出率有一定影响，患者年龄、肿瘤部位可影响SLNB假阴性率。

Objective To evaluate the feasibility of methylene blue as a method in lymphatic mapping and the effect factors of SLNB identification rate. Methods The results of SLNB in 276 patients with clinical stage T1 -T2 N0M0 breast cancer were analyzed to evaluate the effect factors of identification rate and false-negative rate of SLNB. Results The identification of SLN was carried out using methylene blue . When the mapping time of SLN and lymphatic were controlled in 20 - 30 minutes, the SLN could be visualized easily. SLN was successfully identified in 246 of 276 patients （89.1% ） ,423 SLNs were retrieved（ 1 - 4）. The SLN accurately predicted the status of the axilla in 226 of 246 patients （77.3 % ） yielding a FNR （false negative rate ） of 8.1% （20/246）, false positive rate of 0, and an accuracy of 91.9% （226/241）. For the identified rate of SLN, the clinical stage of T2N0M0 disease was higher than the clinical stage of T1N0M0 disease （P = 0. 046,P 〈 0.05）, Upper outer quadrant and lower outer quadrant were higher than other evidently （ P 〈 0. 0010）. SLNs were easily retrieved in those cases aged above 50 years than below 50 years （P 〈0.001 ）. In the view of false-negative rate of SLNB, the FNR rate in patients of 50 years old was less than older ones （P = 0.037, P 〈 0.05 ）. No significant correlation was found between the stage of TMN, the expression of ER and PR, histologic status and FNR. Conclusion When SLNB was performed using methylene blue, we found age, clinical stage of TMN, the location of tumor had relationship with the identified rate of SLN. Aging and location of tumor may adversely affect FNR of SLNB.