乳腺癌哨位淋巴结活检的临床意义

Clinical significance of sentinel lymph node biopsy for breast cancer

目的 探讨哨位淋巴结 (sentinellymphnode ,SLN)活检术 (SLNbiopsy,SLNB)指导临床腋淋巴结阴性 (cN0 )乳腺癌腋窝淋巴结清除范围的可行性。方法 使用专利蓝或美蓝对 1999年4月～ 2 0 0 0年 8月的 96例cT1～ 3N0M0期乳腺癌患者进行SLNB ,随后行包括全腋淋巴结清除的乳腺癌手术。结果 确定SLN 91例 ,成功率为 94.8%。SLN为 1个者 5 4例 ,占 5 9.3% ;2个者 2 3例 ,占2 5 .3% ;3个以上者 14例 ,占 15 .4%。 91例中 ,2 4例 (2 6 .4% )SLN阳性 ,其中 13例 (5 4.2 % )仅有SLN转移。SLNB的灵敏度为 87.5 % ,特异度为 10 0 % ,阳性结果预测值为 10 0 % ,阴性结果预测值为95 .7%。术中印片细胞学检查的准确率为 92 .1% ,假阴性率为 10 .0 % ,假阳性率为 7.1% ;术中快速病理检查准确率为 98.7% ,假阴性率为 5 .0 % ,假阳性率为 0。免疫组化未发现常规病理检查阴性的SLN有阳性结果。结论 SLN转移状况基本可反映乳腺癌腋淋巴结转移的状况 ;SLNB有望成为指导cN0期乳腺癌腋淋巴结清除范围的手术方法 ;国产美蓝对SLN标识效果与专利蓝相似。

Objective To study the significance of sentinel lymph node(SLN) biopsy (SLNB) in determining the extent of axillary dessection for cN0 breast cancer patients.Methods In 96 patients with cN0 breast cancer, sentinel lymph nodes identified by patent blue V or methylenc blue staining were excised for biopsy. patients then received operations for breast cancer including axillary dessection.Results SLN was identified in 91 patients. The total number of SLN identified was one in 54 cases(59.3%), 2 in 23 cases(25.3%) and ≥3 in 14 cases(15.4%). In 24 of the 91 patients, SLN was positive for metastasis. In 13 the 24 patients, only SLN provided evidence of lymph node metastasis. The sensitivity of SLN biopsy was 87.5%, the specificity was 100%. It had 100% positive predictability and 95.7% negative predictability of lymph node metastasis. The accuracy rate of intraoperative imprint cytology examination of SLN was 92.1%, with a false negative rate of 10.0% and a false positive rate of 7.1%. The accuracy rate of frozen section examination of SLN was 98.7% during operation, with a false negative rate of 5.0% but without false positive result. Immunohistochemical assay did not help demonstrate metastasis in SLN negative on routine pathologic examination.Conclusion The SLN status can generally be a representation of axillary metastasis, SLNB is useful to determine the extent of axillary dessection in cN0 breast cancer patients. Methylene blue is as effective as patent blue V in the identification of SLN.