乳腺癌前哨淋巴结活检替代腋窝淋巴结清扫在基层医院的临床应用

Clinical application of sentinel lymph node biopsy in breast cancer instead of axillary lymph node dissection in primary hospital

目的探讨在基层医院开展早期乳腺癌前哨淋巴结活检术替代腋窝淋巴结清扫术的临床可行性及应用价值。方法对84例T1-2N0M0期乳腺癌患者于手术时应用亚甲蓝进行前哨淋巴结活检术，依据术前患者意愿分替代组和清扫组，替代组如前哨淋巴结活检阴性则免行腋窝淋巴结清扫，清扫组前哨淋巴结活检后直接行腋窝淋巴结清扫。统计前哨淋巴结检出率、准确率、假阴性率等相关指标，比较两组患者术后并发症及腋窝复发的发生率。结果①检出率为90．4％；清扫组中准确率为96．7％，灵敏度为92．8％，特异性为100％，假阴性率为7．1％，假阳性率为0。②并发症：替代组术后上肢麻木、肿胀、僵硬、肌力减退、腋窝外形改变方面均明显较清扫组减少，两组比较，差异有统计学意义（P〈0．05）。③复发情况：随访21．5个月，替代组出现腋窝复发2例，清扫组1例，两组比较，差异无统计学意义（P〉0．05）。结论应用亚甲蓝进行前哨淋巴结活检，能准确预测早期乳腺癌患者腋淋巴结转移状况，前哨淋巴结活检术替代腋窝淋巴结清扫术后并发症少，复发率低，基层医院仍可将其作为早期乳腺癌患者的安全分期手术。

Objective To explore the clinical feasibility and application value of sentinel lymph node biopsy instead of axillary lymph node dissection for early breast cancer in primary hospital. Methods 84 cases of T1-2N0M0 breast cancer patients were divided into substitution group and the cleaning group. If sentinel lymph node biopsy was negative, no axillary lymph node dissection was performed in the substitution group; cleaning group patients axillary lymph node were dissected after sentinel lymph node biopsy. Sentinel lymph node detection rate, accuracy, false negative rate and other related indicators were analyzed, and postoperative complications and the incidence of axillary recurrence were compared between the two groups. Results ①The detection rate of sentinel lymph node （SLN） was 90.4% in all breast cancer patients; In cleaning group, the accuracy rate was 96.7%, the sensitivity was 92.8%, the specificity was 100%, the false negative rate was 7. 1%, the false positive rate was 0. ②Complications： upper limb numbness, swelling, stiffness, muscle strength decline, changes in the shape of the armpit of substitution group were significantly lower than that of cleaning group, the difference was statistically significant （P 〈0.05）. ③Recurrence： among 21.5 months of follow-up, there was 1 case of axillary recurrence in the substitution group, 2 cases in the cleaning group, and no significant difference between the two groups （P 〉 0.05）. Conclusions Application of methylene blue for sentinel lymph node biopsy can accurately predict early breast cancer patients with axillary lymph node metastasis, sentinel lymph node biopsy instead of axillary lymph node dissection and less postoperative complications, low recurrence rate. It can still be used in primary hospitals for surgical staging in patients with early breast cancer.