前哨淋巴结活检在乳腺癌中的临床应用

The Clinical Application of ldentification and Biopsy of Sentinel Lymph Node in Breast Cancer

目的 :通过术中鉴别乳腺癌前哨淋巴结 ,以证实乳腺癌在淋巴管播散呈序贯性的假说。方法 :本组 4 5例乳腺癌患者 ,术前 10min用美蓝液 4ml注射到肿瘤周围 ,然后行乳腺癌改良根治术 ,或乳腺区段切除加腋窝淋巴清除术。在切除标本中 ,从原发肿瘤周围先解剖出染色淋巴管 ,然后追寻到第一站引流淋巴结 (前哨淋巴结 )。结果 :在 4 5例乳腺癌患者中成功活检出前哨淋巴结 31例 ,成功率 6 9%。活检出前哨淋巴结平均每例 1.2枚 (0～ 3枚 ) ,清除腋窝淋巴结平均每例 11枚 (范围 6～ 2 3枚 )。 71%病例其前哨淋巴结与腋窝淋巴结性质相符 ,2 9%病例仅为前哨淋巴结阳性。无 1例发生淋巴结跳跃性转移。结论 :①用美蓝染色方法 ,可以活检出前哨淋巴结 ,但其检出率不太理想。有必要与核素扫描等方法结合起来。②本研究证实乳腺癌在淋巴管播散呈序贯性的假说。

Objective:To examine the hypothesis that lymphatic dissemination in breast cancer occurs sequentially by identification and biopsy of sentinel node (SN) in breast cancer. Methods:Fourty five patients with breast cancer were studied.Before ten minutes of operation,4ml of methylene blue dye were injected into the tumour,then a modified radical mastectony or segmental mastectony with lymph node dissection(ALND) were performed.In the removed specimen,methylene blue stained channels were dissected from the primary tumour to the sentinel nodes.Results:Thirty one patients (69%) were successfully indentified SLN.An average of 1.2(0-3) nodes per patient were excised as SN,and an average of 11(6-23) nodes were excised In the ALND.In 71% of cases,there was a correlation between the involiement of SN,and the rest of the axillary nodes.In 29% of cases,the SN were only tumour positive.No`skip' metastasis was found.Conclusions:① SN can identified and biopsied using the method of methylene stained,but its success rate is no high ,It is better to combinate dye guided with gamma probe guided method.② This study confirms the sequential nature of lymphatic dissemination.