临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究

Internal mammary sentinel lymph node biopsy in breast cancer patients with clinically positive axillary lymph nodes

目的:评估临床腋窝淋巴结阳性乳腺癌患者行内乳区前哨淋巴结活检术(IM-SLNB)的临床意义。方法:2013年6月至2014年10月对山东省肿瘤医院乳腺病中心就诊的64例临床腋窝淋巴结阳性的原发性乳腺癌患者行前瞻性单臂入组研究,采取腋窝淋巴结清扫术,同时均应用新的核素注射技术进行IM-SLNB。结果:64例患者中内乳区前哨淋巴结(IM-SLN)显像为38例,显像率为59.4%(38/64)。38例IM-SLN显像患者中IM-SLNB成功率为100%(38/38),并发症发生率为7.9%(3/38),IM-SLN转移率为21.1%(8/38)。肿瘤位于内上象限和腋窝淋巴结转移数目较多的患者,其IM-SLN转移率较高(P<0.001和P=0.017)。患者临床获益率为59.4%(38/64),其中12.5%(8/64)另接受了内乳区放疗、46.9%(30/64)避免了不必要的内乳区放疗。结论:临床腋窝淋巴结阳性的乳腺癌应进行IM-SLNB,尤其对于肿瘤位于内上象限及怀疑存在较多腋窝淋巴结转移数目的患者,以获得内乳区淋巴结的转移状态,指导乳腺癌患者内乳区放疗。

Objective：This study was conducted to evaluate the roles of internal mammary sentinel lymph node biopsy （IM-SL-NB） in the treatment of breast cancer patients with clinically positive axillary lymph nodes. Methods：This study is a one-armed clini-cal research conducted from June 2013 to October 2014. A total of 64 breast cancer patients from Shandong Cancer Hospital with clini-cally positive axillary lymph nodes were enrolled in the study. All patients underwent axillary lymph node dissection. Meanwhile, IM-SLNB was performed in all patients using the new injection method of radiotracer. Results：Among the 64 enrolled patients, the visual-ization rate of internal mammary lymph node was 59.4%（38/64）. For the 38 patients who were subjected to visualization of the internal mammary node, the detection rate was 100%（38/38）, and the incidence of complications was 7.9%（3/38）. The metastasis rate of inter-nal mammary lymph node was 21.1%（8/38）. Patients with upper inner quadrant tumors and metastasis of more axillary lymph nodes had a significantly higher chance of developing sentinel lymph node metastasis （P〈0.001 and P=0.017, respectively） than the other pa-tients. The clinical benefit rate of the above mentioned treatment was 59.4%. Among the patients, 12.5%（8/64） received extra internal mammary radiotherapy, whereas 46.9%（30/64） patients avoided the unnecessary internal mammary radiotherapy. Conclusion：IM-SL-NB should be performed in breast cancer patients with clinically positive axillary lymph nodes because IM-SLNB could provide the ac-curate indication of radiation to the internal mammary area, especially for the patients with upper inner quadrant tumors and those with a suspiciously high level of axillary lymph node metastasis.