乳腺癌哨兵淋巴结活检的临床意义

The clinical significance of sentinel lymph node biopsy in the patients with breast carcinoma

目的:探讨乳癌患者哨兵淋巴结组织学状态同腋窝淋巴结状况的一致性及哨兵淋巴结活检替代腋窝(SLN)(SLNB)淋巴结清扫的可行性。方法:用美蓝染色法对例乳癌患者行腋窝淋巴作图,凡腋清扫术中发现蓝染的淋巴结均被确定为50,予以切除并行常规病检,其阴性行连续切片及免疫组化检查;同时对相应腋窝行清扫,所得非蓝染淋巴SLNSLN(SS)(IHC)结即非哨兵淋巴结,予以常规病检,将及之病检结果相比较。(NSLN)SLNNSLN结果:例中发现例,检出率为,50SLN4590%常规病检例阳性例阴性经采用和检查后,又发现例呈阳性,阳性患者占总检测患者的(16SLN;29SLNSSIHC7SLN51.1%23/)。故的准确率、灵敏度、阳性和阴性预测值分别为,,和。例病检阴性而阳性,45SLNB91.1%85.7%100%81%4SLNNSLN假阴性率为。8.9%结论:可准确反映乳癌患者腋窝状况,替代腋窝淋巴结清扫是可行的。

Objective: To study the consistency between the histological status of the sentinel lymph nodes(SLN) and the axillary lymph nodes, and the possibility of using sentinel lymph node biopsy(SLNB) to substitute routine axillary clearance. Methods: Sentinel lymph nodes in fifty patients with breast carcinoma were identified by using methylene blue. All blue-stained nodes were dissected & sent for hematoxylin and eosin(H&E) staining, ,immunohistochemical(IHC) and serial section(SS) examination separately and axillary lymph node dissection was found. All none sentinel lymph nodes(NSLN) were examined by H&E staining. Results: The SLN were identified in 45 of 50 paitents with a detection rate of 90%; 16 cases were found positive with routine examination.. When using SS and IHC, seven more SLN found positive in 29 cases of negative SLN. The positive SLN patients 、account for fifty-one percent of the total patients detected (23/45). So the accuracy ratesensitivity、positive value and negative value of SLNB were 91.1%, 85.7%, 100%, and 81%, respectively, and the false negative rate was 8.9%. Conclusion: SLNB could accurately predict the axillary status of the patients with breast carcinoma. It is possible for SLNB to substitute the routine axillary clearance.