乳腺癌前哨淋巴结活检意义初探

Clinical significance of sentinel lymph node biopsy in breast cancer

目的 :探讨开展乳腺癌前哨淋巴结活检 (Sentinellymphnodebiopsy ,SLNB)的必要性、可行性、准确性及临床应用价值。方法 :对 45例临床、B超及钼靶检测腋窝LN阴性的原发乳腺癌患者 ,术中在原发肿瘤周围注射专利蓝进行腋窝淋巴结切除 (SLNB) ,随后行腋窝淋巴结清扫 (ALND)。术中对部分SLN、术后对全部LN行常规病理检查。结果 :45例患者中 41例检测到SLN ,成功率 91 1%;假阴性率为 6 6 6 %,SLNB总的敏感性是 93 3%,特异性是 96 1%;总的阳性和阴性预测值分别是93 3%和 96 1%。结论 :乳腺癌SLNB是一项有实用价值的新技术 ,目前国内外仍在研究阶段 ,随着研究的扩大与深入将有可能取代常规的ALND。

Objective:To study the necessity, feasibility, accuracy and clinical value of sentinel lymph node biopsy(SLNB) in breast cancer.Methods:Our study enrolled 45 patients of primary breast cancer with clinically, ultrasonographically and mammographically negative axillae. Mapping procedures and SLND were performed using patent blue dye injected at the primary breast cancer site followed by axillary lymph node dissection(ALND). Sentinel lymph node (SLN) was examined by using frozen sections intraoperatively and all of the axillary nodes were evaluated pathologically(HE) after operation.Results:Sentinel nodes were indentified in 41(91.1%) of 45 procedures. In 1(2.4%) of 41 cases, the SLN was false-negative. The overall sensitivity of the SLN technique was 93.3%, with a specificity of 96.1%. The overall positive and negative predictive values were 93.3% and 96.1%.Conclusion:SLN identification has clinical value for early breast cancer, it is a new technology, though still under investigation, may in the future substitute routine axillary lymph node dissection in the management of breast cancer.