乳腺癌前哨淋巴结活检中亚甲蓝与亚甲蓝、同位素联合示踪的比较研究  

Methylene blue dye versus combined blue dye-radioactive tracer in the detection of sentinel lymph node in breast cancer

作　　者：刘哲斌[1] 吴炅[1] 黄晓燕[1] 张家新[1] 周敏[3] 程竞仪[3] 平波[2] 杨文涛[2] 沈坤炜[1] 韩企夏[1] 沈镇宙[1] 邵志敏[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系；复旦大学附属肿瘤医院乳腺外科,上海200032 [2]复旦大学上海医学院肿瘤学系；复旦大学附属肿瘤医院病理科,上海200032 [3]复旦大学上海医学院肿瘤学系；复旦大学附属肿瘤医院核医学科,上海200032

出　　处：《中华普通外科杂志》2007年第11期840-843,共4页Chinese Journal of General Surgery

基　　金：上海市科委科研基金资助项目（54119524）、上海市教委曙光计划资助项目

摘　　要：目的比较单用亚甲蓝或联合亚甲蓝及同位素示踪剂在乳腺癌前哨淋巴结活检中的价值及研究影响前哨淋巴结活检准确性的因素。方法收集2005年3月至2006年7月期间行前哨淋巴结活检的164例乳腺癌患者,单用亚甲蓝示踪剂组104例,活检前乳晕旁皮下注射亚甲蓝2ml;亚甲蓝和同位素联合示踪剂组60例,术前肿瘤周围实质中4点注射^99m锝-硫胶体2mCi/4ml,经淋巴显像,术中在γ探测仪引导下行腋窝前哨淋巴结活检。结果前哨淋巴结总的检出率为97.0%（159/164）,准确性为95.0%（151/159）,假阴性率为14.0%（8/57）;联合组检出率、准确率、敏感性、阴性预测值高于亚甲蓝组,联合组的假阴性率为8.7%（2/23）,较亚甲蓝组17.7%的假阴性率为低（6/34）,但差异均无统计学意义（P=0.453）。亚甲蓝组平均每例检测出2.2枚前哨淋巴结,联合组为平均2.5枚（P=0.223）。前哨淋巴结数目≥3和〈3枚的患者假阴性率分别为0%和24.2%（8/33）（P=0.016）。联合组中发现73枚无蓝染仅有热点的前哨淋巴结,故同位素的应用将本组患者的检出率从85.0%（51/60）提高至98.3%（59/60）,假阴性率从21.7%（5/23）降低至8.7% （2/23）。结论在取得一定经验的情况下,亚甲蓝示踪与联合染料、同位素示踪可获得相似的前哨淋巴结检出率、准确率;同位素示踪剂的应用对亚甲蓝示踪起到很好的补充作用;前哨淋巴结检出越多,假阴性率越低。Objective To compare methylene blue dye versus combination methylene blue and radioisotope as a tracer in sentinel lymph node biopsy of breast cancer and the factors associated with the definition of sentinel lymph node biopsy. Method In this study, 164 patients with early breast cancer underwent intraoperative sentinel lymph node biopsy from Mar 2005 to Jul 2006, among them 105 patients accepted parareolar subepithelial injection of 2 ml methylene blue dye alone while 60 patients received combination of dye and peritumoral intraperanchymal injection of radioactive colloid （Tc-99m Sulphur Colloid, 2 mi/4 ml） as the tracer, followed by the lymphoscintigraphy 2 hours later. Sentinel lymph node （SLN） identification guided by ,/detector probe was performed. The lymph nodes concentrating the colloidal material or blue dye and those which were suspected to have metastasis grossly were all removed for pathologic examination. Touch imprint cytopathology was used as intraoperative examination while we used HE staining on conventional paraffin section as our final diagnosis for these sentinel lymph nodes. Factors correlated with identification detection rate were assessed. Results A total of 159 （97.0%） patients had their SLN detected in the intraoperative procedure. The identification rate and the false negative rate of SLN- biopsy （SLNB） was 95. 0% （ 151/159） and 14. 0% （ 8/57 ） respectively. False negative rate of SLNB in dye alone group was 17. 7% （6/34） , lower than that in the combination group （8. 7% , 2/23 ） , P = 0. 453. There were no differences in detection rate or identification rate between these two groups. The combination group detected not statistically different number of SLN than dye alone group （2.5 vs. 2.2） , P = 0. 223. The false negative rate of patients with less than 3 SLN biopsied was 24. 2% （8/33）, which was significantly different from that of patients with more than 2 SLN——0% （ P = 0. 016 ）. Radioisotope helped find 73 lymph nodes not blue dyed, th

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 亚甲蓝 同位素 

分 类 号：R686[医药卫生—骨科学]