单用蓝染料示踪剂在乳腺癌前哨淋巴结活检中的价值

Value of Blue Dye as A Single Tracer for Sentinel Lymph Node Biopsy in Breast Cancer

目的探讨单用蓝染料示踪剂在乳腺癌前哨淋巴结活检术(SLNB)中的临床价值。方法本研究共纳入308例患者,均采用联合法(蓝染料联合核素示踪剂)进行SLNB,分别记录单用蓝染料和联合法行SLNB的相关数据并进行对比分析。结果染料法与联合法行SLNB的成功率(93.5%比99.4%,P=0.000)、假阴性率(14.8%比3.3%,P=0.007)、准确性(89.6%比97.8%,P=0.006)和阴性预测值(74.0%比93.3%,P=0.012)的差异均有统计学意义。2种方法的成功率及假阴性率与患者年龄、肿瘤大小、肿瘤部位、组织学类型、肿瘤切检方式、乳房手术方式以及ER、PR和HER-2状况均无关(均P>0.05)。染料法的假阴性率在临床腋淋巴结可疑肿大者中显著升高(P=0.042),并随前哨淋巴结检出数目增多而逐渐降低(P=0.000)。结论与联合法相比,染料法SLNB的成功率、准确性和阴性预测值显著降低,假阴性率显著升高,推荐临床实践中应尽量采用联合法,避免单用染料示踪剂进行SLNB。

Objective To explore the clinical value of only using blue dye as tracer in the sentinel lymph node biopsy（SLNB） of breast cancer.Methods SLNB was performed with the guidance of the combination of blue dye and isotope in all patients enrolled.SLNB data of blue dye only,and the combination method was recorded respectively for analyses.Results Three hundred and eight patients were enrolled in this prospective study.Significant differences were found in the identification rate（IDR,93.5% vs.99.4%,P=0.000）,the false negative rate（FNR,14.8% vs.3.3%,P=0.007）,the accuracy rate（AR,89.6% vs.97.8%,P=0.006）,and the negative predictive value（NPV,74.0% vs.93.3%,P=0.012） between the blue dye alone and the combination method.The IDR and the FNR of the two methods were not significantly associated with the patient age,tumor size and location,histopathological type,type of biopsy and breast surgery,or ER,PR,and HER-2 status（all P0.05）.The FNR of blue dye alone was significantly associated with clinically suspicious turgescence of axillary lymph nodes（P=0.042） and decreased followed by the increased number of sentinel lymph nodes obtained（P=0.000）.Conclusions Compared with the combination method,SLNB guided with blue dye alone had significantly poorer IDR,AR,and NPV,and higher FNR.It is recommended that the combination of dye and isotope should be adopted for the guidance of SLNB in clinical practice rather than the use of blue dye alone.