前哨淋巴结活组织检查在早期乳腺癌局部切除术后的临床应用

Clinical application of sentinel lymph node biopsy in patients with early breast cancer after local excision surgery

目的探讨前哨淋巴结活组织检查(SLNB)在早期乳腺癌局部切除术后的临床应用价值。方法回顾性分析2012年3月至2018年11月在山西白求恩医院行SLNB的经肿物切除活组织检查确诊且临床分期为Tis/T1~2N0M0的93例乳腺癌患者,将成功检出前哨淋巴结(SLN)的患者分为SLN阳性组(转移)和SLN阴性组(无转移),通过临床病理资料分析乳腺肿物切除活组织检查后SLN转移及SLN检出数的影响因素。结果93例患者中87例成功检出SLN,检出率为93.5%(87/93),共检出SLN 255枚,每例患者平均检出2.93枚。均进行了术中快速冷冻,共检出11例SLN阳性患者。17例患者行腋窝淋巴结清扫(包括11例SLN阳性和6例SLN未检出患者),14例SLN术后石蜡病理证实为阳性,其中13例为宏转移,1例为微转移;SLN术中冷冻病理诊断的假阴性率为2.1%(3/14)。单因素分析结果显示,组织学分级、是否有脉管内癌栓与局部切除术后乳腺癌SLN转移有关;SLN检出数受体质量指数及染色方法的影响;美兰法联合核素法可提高SLN的检出率(均P<0.05)。多因素分析结果显示,肥胖患者SLN未检出是正常患者的2.651倍(95%CI 1.592~8.194,P=0.010)。结论对乳腺肿物切除术后早期乳腺癌患者采用适当示踪方法,行SLNB具有较高的检出率和临床应用价值。

Objective To explore the clinical application value of sentinel lymph node biopsy(SLNB)in patients with early breast cancer after local excision surgery.Methods A total of 93 breast cancer patients with clinical stage Tis/T1-2N0M0 who underwent SLNB and were confirmed by using tumor mass excision biopsy from March 2012 to November 2018 in Shanxi Bethune Hospital were retrospectively analyzed.According to the postoperative paraffin pathology,the patients who were successfully detected sentinel lymph node(SLN)were divided into SLN-positive group with metastasis or SLN-negative group without metastasis.The clinicopathological data were used to analyze influencing factors of SLN metastasis and SLN detection number after excision biopsy of breast masses in the two groups.Results A total of 87 out of 93 patients were successfully detected SLN and the detection rate was 93.5%(87/93).A total of 255 SLN were detected,and the average number was 2.93 in per patient.All were subjected to rapid intraoperative freezing pathological,and 11 cases with positive SLN were detected.There were 17 patients who underwent axillary lymph node dissection(ALND),including 11 cases with positive SLN and 6 cases with SLN undetected.The paraffin pathology showed that 14 patients were confirmed as positive SLN,including 13 macrometastasis and 1 micrometastasis.The SLN false negative rate was 2.1%(3/14)of intraoperative frozen diagnosis.Univariate analysis showed that histological grade and intravascular thrombus of carcinoma were associated with SLN metastasis after breast cancer local excision;the number of SLN detection was effected by body mass index and staining method;the methylene staining method combined with radionuclide method could improve the detection rate of SLN(all P<0.05).Multivariate analysis showed that the SLN non-detection of obesity patients was 2.651 times as much as that of normal patients(95%CI 1.592-8.194,P=0.010).Conclusion The SLNB and appropriate tracer method will have a high SLN detection rate and better clinical application value for early breast cancer patients after breast mass resection.