乳腺导管原位癌行前哨淋巴结活检指征的探讨

Discussion of the Sentinel Lymph Node Biopsy for the Treatment of Ductal Carcinoma in Situ

目的:分析乳腺导管原位癌的前哨淋巴结临床及病理特征,探讨乳腺导管原位癌患者实施前哨淋巴结活检的指征。方法:回顾性分析2002年10月到2010年11月期间诊断为乳腺导管原位癌并行前哨淋巴结活检的46例患者的的前哨淋巴结状态及其与其他临床及病理特征的关系。结果:患者的年龄、肿瘤大小、检出SLN数、肿瘤分级、切缘状态、DCIS类型、是否伴随坏死均无显著统计学意义(P>0.05)。可能与乳腺导管原位癌患者前哨淋巴结阳性的几个因素为:年龄41岁-69岁、肿瘤大小1.1 cm-5.0cm、切缘状态未知、肿瘤坏死伴随或未知、肿瘤分级Ⅰ级以上或未知。结论:以下几个因素可能对预测DCIS患者可能出现SLN阳性提供帮助,临床在遇到出现这些因素的DCIS患者需慎重考虑其治疗策略,这些因素包括:年龄41岁-69岁、肿瘤大小1.1cm-5.0 cm、切缘状态未知、肿瘤坏死伴随或未知、肿瘤分级Ⅰ级以上或未知。

Objective： To analyze the characteristics of the ductal carcinoma in situ patients who were undergoing the sentinel lymph node biopsy and to discuss the indications that ductal carcinoma in situ patients should undergo sentinel lymph node biopsy. Methods： A retrospective analysis was performed about the status of sentinel lymph node and their clinical and pathological characteristi- cs of the ductal carcinoma in situ patients who were undergoing the sentinel lymph node biopsy in our hospital from October 2002 to November 2010. Results： The results of multiple logistic regression analysis showed that there was no statistically significant difference about these factors, including age, tumor size, number of SLN excised, tumor grade, margin status, type of DCIS or accompanied with necrosis （P〉0.05）. However, there were still some factors that might be correlative to the node positive of DCIS patients, which are age between 41-69, size of tumor 1.1 cm-5.0 cm, unknown status of the margin, with necrosis or unknown, tumor grade II III or unknown. Conclusions： It is suggested that the following factors could help to predict the DCIS for patients who were treated with the positive SLN and we should make careful decision on the treatment for the patients at the age of 41 to 69, with tumor size of 1.1 cm to 5.0 cm, unknown status of the margin, with necrosis or unknown, tumor grade II III or unknown.