腋窝超声联合亚甲蓝示踪剂在乳腺癌前哨淋巴结活检术中的应用研究

Application of axillary ultrasound combined with methylene blue in sentinel lymph node biopsy of breast cancer

目的研究术前腋窝超声联合术中亚甲蓝示踪剂显示淋巴引流导向,在腋窝淋巴结临床阴性的乳腺癌患者前哨淋巴结活检(SLNB)中的应用价值。方法纳入2015年4月—2019年3月接收的临床触诊阴性的乳腺癌患者(n=36)作为研究对象,在蓝染料法下行前哨淋巴结活检,并于术前行腋窝超声检查,对最低位、靠近乳腺的淋巴结进行标记,将其视为观察组,和术中前哨淋巴结位置及病理结果进行对照分析。对照组为同期乳腺癌手术患者(36例),在蓝染料法下行SLNB,术前未行淋巴结超声分析、体表标记。对两组检出率、准确性、特异性、敏感性进行研究。结果观察组腋窝前哨淋巴结检出率(97.22%)高于对照组(72.22%,P<0.05)。术前腋窝超声联合术中亚甲蓝对腋窝淋巴结状态检测的准确性为94.44%、敏感性为96.43%、特异性为77.78%。结论术前进行腋窝超声能够定位前哨淋巴结,较准确判断乳腺癌腋窝淋巴结转移的状况,减少单用亚甲蓝示踪剂时部分无蓝染的缺陷,降低假阴性发生率,值得借鉴,适合基层医院推广应用。

Objective To investigate the value of preoperative axillary ultrasound combined with methylene blue tracer to show lymphatic drainage in sentinel lymph node biopsy ( SLNB) of breast cancer patients with clinically negative axillary lymph nodes. Methods From April 2015 to March 2019,breast cancer patients with clinically negative axillary lymph nodes ( n = 36) were selected as observation group,and were treated with SLNB by methylene blue staining method and axillary ultrasound before operation to mark lymph nodes at low level and near the breast;the intraoperative sentinel lymph node location and pathological results were analyzed. Another 36 breast cancer patients were selected as control group during the same period to perform SLNB by methylene blue staining method,and no lymph node ultrasound analysis and body surface labeling were performed before the operation. The detection rate,accuracy, specificity,and sensitivity between the two groups were compared. Results The detection rate of sentinel lymph node in the observation group ( 97. 22%) was higher than that in the control group ( 72. 22%)( P < 0. 05). The accuracy, sensitivity,and specificity of axillary lymph nodes detected by preoperative axillary ultrasound combined with methylene blue were 94. 44%,96. 43%,and 77. 78%,respectively. Conclusion Preoperative axillary ultrasound can locate the sentinel lymph nodes,accurately determine the status of axillary lymph node metastasis in breast cancer,reduce the defect of partial absence of blue staining with methylene blue tracer alone,and reduce the incidence of false negative, which is suitable for promotion and application in primary hospitals.