前哨淋巴结示踪技术在乳腺癌中的应用

Identification of the Sentinel Lymph Node Applied in Breast Cancer

目的 以^(99m)Tc-硫胶体和亚甲蓝为示踪剂探测乳腺癌前哨淋巴结,评价两种方法在发现前哨淋巴结中的可行性。方法 42例乳腺癌患者,原发肿瘤最大直径均≤5cm,体检腋窝淋巴结阴性。将其随机分成两组,第一组20例,以^(99m)Tc-硫胶体为示踪剂,用γ-探测仪定位前哨淋巴结,其中6例应用术前乳腺淋巴闪烁显像;第二组22例,用亚甲蓝定位前哨淋巴结。两组在行腋窝淋巴结清扫前,均接受前哨淋巴结活检。结果 共发现29例存在前哨淋巴结(69.05％)。以^(99m)Tc-硫胶体为示踪剂组,前哨淋巴结发现率为75％;以亚甲蓝为示踪剂组,前哨淋巴结发现率为63.64％,且与年龄明显相关(P<0.01)。结论 以^(99m)Tc-硫胶体和亚甲蓝为示踪剂探测乳腺癌前哨淋巴结是可行的。所采用的定位技术和掌握技术的熟练程度等是影响前哨淋巴结发现率的因素。

Objective To evaluate the feasibility of two methods in identification of the sentinel lymph node(SLN) from the breast cancer patients, either filtered technetium -labeled colloid and gamma probe or blue dye. Methods A total of 42 patients who suffered from breast cancer, with the largest dimension of the tumor 5cm and negative axillary nodes in physical examination were divided into two groups randomly. Filtered technetium -labeled colloid and gamma probe was used to identify SLNs in group one (20 patients) , in which 6 of them had lymphoscintigraphy, whereas blue dye was used in the subareolar in the group two (22 cases). All of them were performed sentinel lymph nodes biopsy before axillary dissection. Results There were 29 out of 42 (69.05% ) positive identification of SLNs. There were 15 out of 20 (75% ) positive identifications of SLNs in the group one; whereas there were 14 out of 22 (63. 64% ) positive in the group two. In the second group there is a significant correlation between age and positive identifications of SLNs. Conclusion It is feasible to identify the SLNs, using technetium -labeled colloid or blue dye. Positive identification of the SLNs, however, is depended on a number of factors: techniques applied, the competency of the performer, and the patients conditions.