乳腺癌哨兵淋巴结检出相关临床和组织学因素

Clinical and histological factors associated with sentinel node identification in breast cancer

目的 探讨乳腺癌术中哨兵淋巴结 (sentinellymphnode ,SLN)检出成功率的预测因素。方法 应用原发肿瘤周围注射 1%亚甲蓝示踪方法对 10 8例Ⅰ、Ⅱ期原发乳腺癌患者进行哨兵淋巴结活检 (sentinellymphnodebiopsy ,SLNB) ,随后行包括腋窝淋巴结清扫 (ALND)在内的乳腺癌手术。通过分析评估临床和组织学因素 ,确定术中SLN成功检出的相关因素。 结果 10 8例患者术中行SLNB ,84例成功证实SLN(77 78% )。在被评估的临床因素中 ,年龄 <5 0岁 (χ2 =7 4 4 7,P <0 0 1)、原发肿瘤位于上、外象限 (χ2 =6 330 ,P <0 0 5 )、术前穿刺活检确诊 (χ2 =5 5 0 9,P <0 0 5 )、淋巴管示踪成功 (χ2=13 12 5 ,P <0 0 1)明显地与术中SLN的成功证实有关。组织学因素与SLN的检出无关。 结论SLNB过程中SLN检出可能失败。术中SLN证实最好的预测因子是淋巴管示踪成功 ,另外的因素如年龄 ,肿瘤位置和确诊方法对SLN的成功检出同样重要。

Objective To study the predictive factors that are associated with intraoperative identification of the sentinel lymph node(SLN). Methods Lymphatic mapping using blue dye was performed in 108 patients with stage Ⅰ and Ⅱ operable primary breast cancer. Subsequently the patients received operations of breast cancer including axillary dissection. Clinical and histological factors were assessed to determine those that were associated with intraoperative identification of the SLN. Results The sentinel node was identified at the time of surgery in 84 patients (77 78%).Of the clinical factors assessed, age(y) <50 (χ 2=7 447, P< 0 01), tumour in the upper quadrant (χ 2=6 330, P< 0 05), diagnosis by preoperative biopsy (χ 2=5 509, P< 0 05), successful mapping of the lymphatic duct (χ 2=13 125, P< 0 01) were significant in identifying the sentinel node at operation. No histological factor was associated with intraoperative identification of the sentinel node. Conclusion There are the possibility of failure of SLN identification at sentinel lymph node biopsy. Our results suggest that the best predictor of intraoperative sentinel node identification is the visualization of the lymphatic duct on mapping by blue dye. Other factors such as age, tumour site as well as dignostic method are also important in determining the success of the procedure.