乳腺癌前哨淋巴结的定位与活检

Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Patients with Breast Cancer

目的 探讨乳腺癌前哨淋巴结定位与活检技术的可行性和前哨淋巴结能否准确预告腋淋巴结状况。方法 应用美蓝对 3 2例乳腺癌患者进行术中及术后前哨淋巴结定位与活检。结果 2 6例 (81.2 5 % )检出前哨淋巴结 ,且均集中在levelⅠ区域。用美蓝定位前哨淋巴结预告腋淋巴结转移的敏感性为 77.78% (7/9) ,准确性为 80 .77% (2 1/2 6) ,特异性为 82 .3 5 % (14 /17) ,假阴性率为 2 2 .2 2 % (2 /9)。结论 前哨淋巴结虽能预测腋淋巴结状态 ,但要取代腋淋巴结清扫还需进一步研究。

Objective To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SLNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary lymph node.[WT5”HZ]Methods [WT5”BZ]From March to October 2000, 32 patients with breast cancer were evaluated at the Sichuan Provincial People’s Hospital. Lymphatic mapping was performed using Methlene Blue. A SLN was defined as any blue node. Thirty-two patients, with breast cancer underwent a complete axillary lymph node resection (ALNR) following SLN biopsy. Subsequently, all SLNs and ALNs were examined by both H&E staining as well as immunohistochemical staining for cytokeratin. [WT5”HZ]Results [WT5”BZ]Lymphatic mapping was successful in identifying the SLN in 26/32(81.25%) cases of nodes at level Ⅰ. Of the 26 patients mapped successfully, 10 had metastasis to the SLNs.In 3 cases that SLNs were positive, but other axillary lymph nodes were negative. In 2 cases that the SLNs were negative, but other axillary lymph nodes were positive. The sensitivity of SLNB using Methlene Blue in this study was 77.78%(7/9), accuracy 80.77%(21/26), specificity 82.35%(14/17), and false negative rate 22.22%(2/9). [WT5”HZ]Conclusion [WT5”BZ]SLN can predict the status of the axillary lymph nodes reliably. However, the efficacy of SLNB in the setting of randomized, prospective trials must be tested first before abandoning axillary lymph node resection as the standard of care. [WT5”HZ]