新型前哨淋巴结活检技术在选择性腋窝淋巴结清扫中的应用

Application of new sentinl lymph node biopsy technique in selective axillary lymph node dissection

目的 采用经前哨淋巴通道（SLC）行前哨淋巴结活检（SLNB）新技术,判断腋窝淋巴结状态及指导选择性腋窝淋巴结清扫（ALND）.方法 采用非随机对照研究,通过前哨淋巴通道行SLNB.根据前哨淋巴结（SLN）的术中病理结果行选择性ALND的患者为A组,其中SLN为阳性,行ALND为A1组,SLN为阴性,仅行SLNB为A2组;无论SLN状态,SLNB后均行ALND的患者为B组.结果 2008年7月至2009年6月共114例早期乳腺癌患者行SLNB,检出i12例,A1组28例,A2组25例,B组59例.联合法和染料法检出率为分别为98.1%（102/104）和100.0%（10/10）,两者差异无统计学意义（P〉0.05）.假阴性率为2.30%（2/87）,假阳性率为0.89%（1/112）.检出SLN1～4枚,共146枚,平均1.3枚.ALND组（A1＋B）并发症发生率（52.9%）高于SLNB组（A2）并发症发生率（4.0%）（χ^2=15.9675,P〈o.01）.结论 新型SLNB技术寻找SLN准确可靠,显著降低假阴性的发生,较好地指导选择性的ALND,减少术后并发症,SLNB的假阳性等问题需要进一步研究.

Objective To identify the status of sentinel lymph nodes （SLNs） and direct selective axillary lymph node dissection （ALND） according to the results of new sentinel lymph node biopsy （SLNB） technique following sentinel lymph channel （SLC）. Methods In this prospective non-randomized study, all patients received SLNB following SLC. Patients in group A received selective ALND according to the intraoperative pathologic results of SLNs （Patients in group A1 received ALND when the SLNs were positive,and patients in group A2 received SLNB only in case of negative SLNs） ,and all patients in group B received ALND following SLNB whatever the status of SLNs were. Results From July 2008 to June 2009,114 patients with early breast cancer received SLNB,and 112 patients＇ SLNs were identified. Twenty-eight,25 and 59 patients were selected as groups Al ,A2 and B,respectively. The dissection rate of SLNB with combined method and blue dye method was 98.1% （102/104） and 100.0% （10/10） （P 〉0.05） .respectively, the false negative rate was 2.30% （2/87） and the false positive rate was 0.89% （1/112）.The number of SLN harvested by SLNB was 1-4 with a tot of 146 and an average of 1.3 per patient. The incidence of complication for ALND （52.9%） was higher than that for SLNB （4.0%） （χ^2 = 15.9675, P 〈 0.01）. Conclusion The new SLNB technique was accurate and reliable, which can decrease the false negative rate notably, direct selective ALND efficiently and decrease the complication.