亚甲蓝在新辅助化疗后乳腺癌前哨淋巴结活检中的应用研究

Application of methylene blue dye to Sentinel Lymph Node Biopsy in breast cancer after neoadjuvant chemotherapy

目的探讨乳腺癌新辅助化疗后单用亚甲蓝行前哨淋巴结活检的可行性及准确性。方法对68例乳腺癌患者先行3～4周期的新辅助化疗,然后单用亚甲蓝行前哨淋巴结活检术,前哨淋巴结活检后均行腋窝淋巴结清扫术(LevelⅠ、Ⅱ),前哨淋巴结及腋窝的淋巴结状况由石蜡连续切片、HE染色进行病理诊断。结果本组新辅助化疗后患者前哨淋巴结检出率为90%(61/68),假阴性率为9%(3/32),准确率为95%(58/61),灵敏度为91%(29/32)。平均每例检出前哨淋巴结2.1枚。患者月经状况、病理类型、肿块的位置、新辅助化疗方案、疗效对前哨淋巴结的检出率及假阴性率均无影响,而化疗后肿瘤的直径及肿瘤脉管内侵犯影响前哨淋巴结的检出率,但不影响假阴性率。患者均未发生变态反应及皮肤坏死。结论单用亚甲蓝可在新辅助化疗后乳腺癌前哨淋巴结活检中准确预测腋窝淋巴结的状况,并且安全可靠,但化疗后肿块的直径及肿瘤的脉管内侵犯可能是影响检出率的因素,需进一步提高检出率并降低假阴性率。

Objective It is to investigate the feasibility and accuracy of sentinel lymph node biopsy（SLNB） using methylene blue dye alone method in patients with breast cancer after neoadjuvant chemotherapy（NAC）.Methods Sixty-eight patients,biopsy proven cases of breast cancer that had received three or four cycles of neoadjuvant chemotherapy were carried out SLNB using methylene blue dye alone followed by complete axillary lymph node dissection（Level Ⅰ,Ⅱ）.The status of all sentinel lymph nodes and axillary lymph nodes were examined pathologically with HE staining.Results In this study the identification rate of SLNs was 90%（61/68）.The false negative rate was 9%（3/32）.The accuracy and sensitivity of SLN were 95%（58/61）and 91%（29/32）respectively.The average number of SLNs harvested was 2.1 in each patient in our study.The menopausal,pathological type,the location of mass,the scheme and effect of neoadjuvant chemotherapy had no effect on the identification rate and false negative rate of SLNs,but diameter of the mass after NAC and lymphvascular invasion were the factors that affected the identification rate of SLNs.No allergic reaction and skin necrosis had been observed.Conclusion SLNB using methylene blue dye as a sole mapping agent is safe and accurate to predict the status of axillary lymph nodes after neoadjuvant chemotherapy.Diameter of mass after neoadjuvant and lymphovascular invasion may affect the rate of identification.Improving trace technology is needed to enhance the accuracy for the patients with above factors.