乳腺癌内乳前哨淋巴结转移临床特点研究

Clinical study of internal mammary sentinel lymph node metastasis in breast cancer

目的研究乳腺癌内乳前哨淋巴结转移患者的临床特点。方法246例患者术前均注射亚甲蓝及99mTc硫胶体双示踪剂寻找内乳区前哨淋巴结(internal mammary sentinel lymph node,IMSLN)及腋窝前哨淋巴结(axillary sentinel lymph nodes,ASLN),经病理组织学检查,分析IM-SLN转移与患者的年龄、肿瘤直径、位置、分子分型、ASLN的关系。结果246例患者中32例IM-SLN显像,显像率为13.01%(32/246),IM-SLN显像状况与原发肿瘤位置(χ^(2)=26.063,P<0.05)、肿瘤直径有相关性(χ^(2)=45.518,P<0.05)、ASLN数目(χ^(2)=138.661,P<0.05)有相关性,与患者年龄、分子分型无相关性(P>0.05)。246例患者IM-SLN转移32例,转移率为13.01%(32/246),其中ASLN转移数目≥4枚时转移率最高为8.13%(20/246);当肿瘤直径≥2 cm时IM-SLN转移率为12.20%(30/246)。结论乳腺癌原发肿瘤位于内象限、伴ASLN转移或肿瘤直径≥2 cm容易出现IM-SLN转移。

Objective To explore the clinical and pathological features of breast cancer with internal mammary sentinel lymph node(IM-SLN)metastasis.Methods A total of 246 patients preliminarily diagnosed with early breast cancer were selected,and all of them were documented with breast cancer by biopsy pathology.Before surgery,every patient was injected with methylene blue and 99 mTc sulfur colloid dual tracers to detect IM-SLN and axillary sentinel lymph nodes(ASLN),which were subject to histopathologic examination.The correlations of IM-SLN metastasis with patient age,tumor size,tumor site,molecular subtype,and ASLN metastasis were analyzed.Results The imaging rate of IMSLN was 13.01%(32/246).The imaging status of IM-SLN was correlated with the location of primary tumor(χ^(2)=26.063,P<0.05),tumor diameter(χ^(2)=45.518,P<0.05)and the number of ASLN(χ^(2)=138.661,P<0.05),but not with age and molecular type(P>0.05).Among the 246 patients,32 cases had IM-SLN metastasis,and the metastasis rate was 13.01%(32/246).The highest metastasis rate was 8.13%(20/246)when the number of ASLN metastasis was more than 4,and the metastasis rate was 12.20%(30/246)when the tumor diameter was more than 2 cm.Conclusion Breast cancer patients whose tumors are located in the inner quadrant or with ASLN metastasis or whose tumors are greater than or equal to 2 cm are the main clinical features of IM-SLN.