超声定位下可疑淋巴结取样在早期乳腺癌手术中的临床研究

Value of doppler ultrasound hook-wire-guided suspicious node biopsy in early breast cancer

目的探讨早期乳腺癌更为合理的腋窝淋巴结处理方法，明确腋窝可疑淋巴结取样结合前哨淋巴结活检（SLNB）替代单纯SLNB时的假阴性率是否明显降低，为临床应用提供依据。方法采用传统的腋窝淋巴结外科学分群方法，对符合入组条件的42例早期乳腺癌患者术前行B超引导下钩丝定位，术中行腋窝SLNB和定位的可疑淋巴结活检，再行全腋窝淋巴结清扫（ALND）或levelⅡ水平的腋淋巴结清扫，对SLN、可疑淋巴结、腋窝其余的淋巴结分3组行病理检查，比较单纯SLNB与SLNB配合可疑淋巴结取样活检预测腋淋巴结状态的差异。结果SLNB总成功率为100％（42／42），SLNB2例假阴性，假阴性率11％（2／18），敏感性88．9％（16／18），准确率95．2％（40／42）。SLNB配合可疑淋巴结活检预测腋淋巴结状态未见假阴性，敏感性100％（18／18），准确率100％（42／42）。结论超声引导可疑淋巴结钩丝定位取样有降低乳腺癌SLNB假阴性率的趋势，但本组样本数少，差异无统计学意义（P=0．2500）。

Objective To explore ideal surgical axillary management of early breast cancer, and to determine the feasibility of reducing false negative rate of sentinel lymph node biopsy （SLNB） by combination of axillary suspicious lymph node biopsy and SLNB. Methods From Jan. 2008 to Oct. 2009, 42 consecutive cases with early breast cancer were enrolled. All patients underwent suspicious node hook-wire location by doppler ultrasonography before operation. SLNB and suspicious lymph node biopsy were performed during operation. Complete axillary nodes dissection （ALND） or level Ⅱ dissection would be conducted according to the biopsy result. The difference of node status prediction between SLNB and SLNB with axillary suspicions lymph node biopsy and was compared. Results All the 42 cases successfully underwent SLNB （100%）. There were 2 false negatives occurred in SLNB, resulting in false negative rate of 11% , sensitivity of 88.9% and accuracy of 95.2% in predicting axillary nodes status. By contrast, SLNB with axillary suspicious node biopsy showed a false-negative rate of 0% , sensitivity of 100% , and accuracy of 100%. Conclusions Compared to SLNB in early breast cancer, combination of suspicious node biopsy and SLAB has a tendency of reducing false negative rate. However, Because of the limited samples, the difference has no statistical significance （P = 0. 2500）.