中国乳腺癌前哨淋巴结活检验证阶段研究结果的系统评价

Systematic review of validation phase of breast cancer sentinel lymph node biopsy results in China

目的通过对国内近年来有关乳腺癌前哨淋巴结活检术（SLNB）文献的统计与分析，了解国内前哨淋巴结活检术在乳腺癌治疗中的研究及应用现状。方法以国内公开发行的期刊为依据，以“乳腺肿瘤（breasttumor）”、“前哨淋巴结（SLN）”、前哨淋巴结活检术（SLNB）“为关键词，文献截取时间为1999年1月至2005年12月，通过中国生物医学文献数据库（CBM）、万方数据库和CNKI检索系统进行检索。对检出的文献进行筛选，共人选与乳腺癌前哨淋巴结活检研究相关的88篇论著类文献，增加2篇新近与乳腺癌前哨淋巴结活检研究相关文献。采用SPSS10．0统计学分析软件进行统计前哨淋巴结活检的成功率，准确性，假阴性率及灵敏度等指标。结果所有患者（共6282例）SLNB检出成功率为90．82％（5705／6282），总体假阴性率为9．69％（259／2671）。前哨淋巴结对腋窝淋巴结状况预测的总体敏感性、特异性、假阳性率、准确性、阴性预测值及阳性预测值分别为90．30％、99．64％、0．41％、86．52％、92．11％及99．55％。结论SLNB能够准确预测腋窝淋巴结的转移状况；SLNB检出率与患者年龄和肿瘤部位有相关性，检出率和假阴性率均与示踪剂注射部位无关，联合法具有较高的检出率和较低的假阴性率；SLN更有可能是乳房整个器官的SLN，而非乳房某个具体部位的SLN，SLN的解剖学定位是固定的，与示踪剂注射的部位无关，也即与原发肿瘤的部位无关。

Objective To explore the studies and application status of sentinel lymph node biopsy （SLNB） in breast cancer in China by statistically analyzing the relevant domestic literature. Methods The literatures published from January 1999 to December 2005 were searched in the databases of ChinaInfo, CBM and CNKI retrieval system with ＂breast tumor, SLN and SLNB＂ as the key words. A total of 88 manuscripts were selected with 2 new reports of SLNB. The successful rate, accuracy, false-negative rate and sensitivity of SLNB were analyzed by SPSS 10. 0 statistical analysis software. Results Among a total of 6282 patients, the detection rate of SLNB was 90. 82% （5705/6282） and the overall false-negative rate 9. 69% （259/ 2671 ）. The prediction sensitivity, specificity, false positive rate, accuracy, negative and positive predictive value of SLN for axillary lymph nodes status were 90. 30%, 99.64% , 0. 41%, 86. 52%, 92. 11% and 99. 55% respectively. Conclusion SLNB can accurately predict the axillary lymph node metastasis. And its detection rate is correlated with patient age and tumor location. The detection rate and false-negative rate has nothing to do with the tracer injection site. A combined regimen has a higher detection rate and a low false negative rate. Affecting the whole breast, SLN is not correlated with a particular area of breast. The validation phase of SLNB in breast cancer is currently feasible in China.