乳腺癌腔镜下腋窝前哨淋巴结活检术的可行性研究

Feasibility study of the axillary sentinel lymph node biopsy of breast cancer under endoscopy

目的：探讨乳腺癌腔镜下腋窝前哨淋巴结活检术（ESLNB）的临床可行性。方法选取2010年1月至2013年10月日照市人民医院外科收治住院的45例早期乳腺癌患者。首先行 ESLNB，所获前哨淋巴结送术中快速病理和术后病理检查，然后行腋窝淋巴结清扫术（ALND）将所获淋巴结送术后病理检查。评价 ESLNB 的灵敏度、准确率、假阴性率和假阳性率。将 ESLNB 与 ALND 对腋窝淋巴结转移情况的评估结果进行对比。结果成功检出前哨淋巴结43例，成功率为95.6%。ESLNB 术中快速病理检查的灵敏度为90.1%，准确率为88.4%，假阴性率为9.1%，假阳性率为6.06%；ESLNB 术后病理检查的灵敏度为93.9%，准确率为90.1%，假阴性率为6.06%，假阳性率为6.06%。ESLNB 术中快速及术后病理检查与 ALND 术后病理检查对腋窝淋巴结转移状况的评估结果比较差异无统计学意义（P ﹥0.05）。结论亚甲蓝染色法行乳腺癌腔镜下腋窝前哨淋巴结活检术安全可行，为缩小乳腺癌的手术范围开辟了新的途径。

Objective To investigate the clinical feasibility of the axillary sentinel lymph node biopsy under endos-copy for breast cancer. Methods From January 2010 to October 2012,45 patients with early breast cancer in people’s hospital of Rizhao were chose. The patients were performed with ESLNB at first,and the obtained sentinel lymph nodes were sended for intraoperative rapid pathologic and postoperative pathologic examination,and then the axillary lymph nodes were obtained by axillary lymph node dissection（ALND）,the obtained axillary lymph nodes were sended for postoperative pathologic examination. The sensitivity,accuracy,false negative rate and false positive rate of ESLNB was evaluated. The assessment results of axillary lymph node metastasis situation by ESLNB and ALND were compared. Results Forty-three sentinel lymph nodes were successfully detected,the success rate was 95. 6% . The sensitivity of ESLNB intraoperative fast pathologic examination was 90. 1% ,and the accuracy rate was 88. 4% ;the false negative rate was 9. 1% ,and false posi-tive rate was 6. 06% ;The sensitivity of ESLNB postoperative pathologic examination was 93. 9% ,and the accuracy rate was 90. 1% ;the false negative rate was 6. 06% ,and the false positive rate was 6. 06% . There was no significant differ-ence in the evaluation results of axillary lymph node metastasis status between ESLNB intraoperative rapid / postoperative pathologic examination and ALND postoperative pathologic examination（P ﹥ 0. 05）. Conclusions The axillary sentinel lymph node biopsy of breast cancer by endoscopic surgery through methylene blue staining is feasible and safe. It opens a new route for narrowing the operation scope of breast cancer.