乳腺癌前哨淋巴结活检的临床研究

Clinical Study of Sentinel Lymph Node Biopsy in Breast Cancer

目的 探讨乳腺癌前哨淋巴结活检 (SLNB)的临床应用价值 ,分析影响检出率的相关因素。方法 在乳腺肿瘤表面或活检部位周围皮下组织注射99mTc标记的硫胶体 ,采用核素淋巴显像和γ计数器探测仪检测识别前哨淋巴结 (SLN ) ,先行SLNB ,随后行乳腺癌改良根治术。结果 5 0例患者中SLN检出率为 96.0 % ;敏感度为 88.2 % ;准确性为 95 .8% ;假阴性为11.8% ;假阳性为 0。患者年龄 <5 0岁、原发肿瘤位于乳腺外上象限、术前穿刺活检确诊与SLN检出有关 (P <0 .0 5 ) ;是否绝经、肿瘤大小、病理类型、雌激素受体 (ER)、孕激素受体 (PR)与SLN检出无关 (P >0 .0 5 )。结论 SLNB具有安全可靠、敏感度和准确性较高等特点 ,可以正确反映大多数乳腺癌患者腋窝淋巴结 (ALN )

Objective To evaluate the clinical feasibility of sentinel lymph node biopsy(SLNB) in breast cancer and study the associated factors with identification of sentinel lymph node(SLN).Methods Technetium-99m( 99mTc-DX) labeled colloid particles were injected subcutaneously surrounding the primary breast cancer.The SLNs were identified by lymphoscintigraphy.The SLNB guided by γ-counter probe was performed before the modified mastectomy.Clinical and histological factors were analyzed statistically.Results Of 50 cases,48 cases(96.0%) showed positive SLN.The sensitivity of SLNB technique was 88.2%,the accuracy was 95.8%,the false negative rate was 11.8% and the false positive rate was 0.The patient Age(<50 years),tumor position(in the upper quadrant),diagnosis method(preoperative biopsy) were related with the identification of SLN at operation(P<0.05).Menstruation,tumor size,histological type,ER and PR status were not associated with intraoperative detective rate of the SLN(P>0.05).Conclusion SLNB is a safe and reliable technique with minimal morbidity.It has a high accuracy and sencitivity in prediction of ALN metastasis.