前哨淋巴结活检指导保留乳房手术患者行选择性腋窝淋巴结清除术的研究

Study of sentinel lymph node biopsy in directing selective axillary lymph node dissection in patients receiving breast-conserving therapy

目的研究通过前哨淋巴通道(SLC)行前哨淋巴结活检(SLNB)以指导保留乳房手术(breast-conserving therapy,BCT)患者行选择性腋窝淋巴结清除术(ALND)的可行性。方法采用非随机对照研究,在BCT患者中采用联合示踪法通过SLC行SLNB。对术中检出的前哨淋巴结(SLN)行细胞印片和冰冻切片检查,根据SLN的术中病理结果行选择性ALND,其中SLN阳性、行ALND者为A组,SLN阴性仅行SLNB者为B组。定性资料的比较选用χ2检验,两组均数的比较采用t检验。结果 2009年1月至2009年12月采用联合示踪法行SLNB的BCT患者共43例,检出42例,A组28例,B组14例。两组患者的SLC均被显影。每例患者被检出SLN1～3枚,平均1.4枚,共被检出59枚。SLNB检出率为97.7%(42/43)。术后病理检查共检出阳性SLN29例,其中术中细胞印片、冰冻切片及二者联合病理检测分别检出阳性淋巴结27、27、28例。A组ALND相关并发症发生率明显高于B组(P=0.003)。结论通过SLC行SLNB有助于准确定位SLN,能够指导BCT患者行选择性ALND,降低术后并发症。

Objective To study the possibility of selective axillary lymph node dissection （ALND） according to the sentinel lymph node biopsy （SLNB） technique through sentinel lymph channel （SLC） in patients receiving breast-conserving treatment（BCT）. Methods In this non-randomized study, the SLNB technique with combinative tracer method through SLC was adopted in all patients receiving BCT. All sentinel lymph nodes（SLNs）were investigated by touch cytology and frozen section. According to the intraoperative pathologic results of SLNs, all patients received ALND or SLNB only. Patients in Group A received ALND when the SLNs were positive, patients in Group B received SLNB only in case of negative SLNs. The data were analyzed by SPSS 10.0. Chi-square test was used for comparison of the qualitative data and t test was used to compare the means between the two groups. Results From Jan. 2009 to Dec. 2009, 43 patients received BCT and SLNB with combinative tracer method. A total of 42 patients were identified with SLNs （28 patients in Group A and 14 patients in Group B）. Patients SLCs of both groups were observed. The number of SLN harvested by SLNB was 1-3 （average, 1.4） per patient. A total of 59 were detected. The dissection rate of SLNB was 97. 7% （42/43）. We found positive SLN in 29 patients. The intraoperative positive SLNs detected by touch cytology, frozen section and joint pathological detection were 27, 27 and 28,respectively. The ALND-related complication rate of Group A was higher than that of Group B （P=0. 003）. Conclusion SLNB through SLC helps to locate SLN accurately,direct selective ALND and decrease complications.