乳腺癌内乳区前哨淋巴结临床研究

Clinical research of internal mammary sentinel lymph node in breast cancer

目的探讨内乳前哨淋巴结的意义及在临床上的应用价值。方法采用核素联合美蓝染色法对58例乳腺癌患者行内乳前哨淋巴结活检术,以病理结果为标准分析内乳前哨淋巴结的相关特性。结果 (1)内乳淋巴结显像率为19%,检出率100%;内乳前哨淋巴结转移率为5%,均伴有腋窝淋巴结转移;(2)内乳前哨淋巴结转移状况与腋窝淋巴结转移状况相关(P<0.05),而与患者年龄、绝经状态、肿瘤大小、位置、术前活检方式及病理类型无关(P>0.05)。结论核素联合美蓝法内乳淋巴结活检成功率低,但有助于对患者分期及判断预后,并可指导个体化治疗。

Objective To explore the signifcance and clinical application value of internal mammary sentinel lymph nodes in breast cancer. Methods Radionuclide combined with methylene blue method was used to 58 cases with early breast cancer for internal mammary sentinel lymph node biopsy, relative characteristics of the IM-SLN with the pathological result were analyzed. Results IM-SLN imaging rate with radionuclide combined with methylene blue method was 19%, the detection rate was 100%, and the IM-SLN metastasis rate was 5%, all of which were associated with axillary lymph node metastasis; patients’ IM-SLN transfer status was signifcantly related with axillary lymph node metastasis status by univariate analysis （P 〈 0.05）, while was irrelated with patients’ age, menopausal status, tumor size, tumor location, preoperative biopsy and pathological types （P 〉 0.05）. Conclusion The success rate of radionuclide combined with methylene blue method of IM-SLNB is low, actually all of these patients have ALN metastasis, who have the indication of radiotherapy in the endosperm area in the NCCN. Therefore, the method of IM-SLNB for this part of patients is not significant. For the patients with only IMLN metastasis, missed diagnosis and inadequate treatment will occur without IMLNB. Therefore, the detection technology and methods of operation need to be improved, and the sample size needs increasing, which is expected to guide the treatment of breast lymph node dissection, and provide accurate staging and individualized treatment for patients.