乳腺癌前哨淋巴结活检的临床意义(附30例报告)

Clinical significance of sentinel lymph node biopsy in breast cancer

目的 探讨开展乳腺癌前哨淋巴结活检 (sentinellymphnodebiopsy ,SLNB)的必要性、可行性、准确性及临床应用价值。方法 术前在乳腺肿瘤下方注射 37MBq放射性胶体99mTc DX ,同时运用核素淋巴显像和γ计数器探测仪探测两种检测方法 ,识别出放射性同位素浓聚的前哨淋巴结(sentinellymphnode ,SLN) ,并用皮肤墨水在相应的皮肤上做出标记。术中根据体表标记切除SLN ,后行腋窝淋巴结解剖 (axilarylymphnodedissection ,ALND) ,两标本同时送病理检查 ,了解其符合率 ,并评价SLNB的可行性。结果 30例均进行了SLN识别定位 ,活检后经病理检查有 2例错误。 1例未取到SLN ,故SLN的检出率为 96 .7% ;1例SLN病理呈假阴性。按目前国外SLNB的评价标准 ,本组SLNB的敏感度为 88.9% ,准确性为 93.3% ,假阳性率为 0 ,假阴性率为 11.1%。结论 乳腺癌SLNB目前在国内外仍处于研究阶段 ,随着研究的扩大与深入将可能取代常规的ALND。

Objective To study the necessity , feasibility , accuracy and clinical value of sentinel lymph node(SLN) biopsy in the management of breast cancer.Methods Technetium 99m labeled colloid particles were injected subcutaneously below the breast tumor before mastectomy. The sentinel lymph nodes identified by lymphoscintigraphy and γ counter were dissected out from the excised axillary tissue and separately examined manually for consistency and histologically.Results In 30 cases studied, SLNs were identified in all but one, with a detection rate of 96.7%. Metastases were dectected in SLNS in 8 cases. The other case showed positive axillary lymph nodes but SLN was negative. The sensitivity of SLN biopsy in this study was 88.9%, accuracy was 93.3%, false positive was 0, false negative was 11.1%.Conclusion SLN biopsy, though still under investigation, may in the future substitute routine axillary lymph node dissection in the management of breast cancer.