术前淋巴显像在乳腺癌前哨淋巴结活检中的作用  

Role of lymphoscintigraphy in sentinel lymph node biopsy in breast cancer patients

作　　者：王磊[1] 胡旭东[1] 李济宇[1] 陈鸣陆[1] 杨国仁[1] 刘岩松[1] 周正波[1] 李永清[1] 刘雁冰[1] 赵桐[1] 陈鹏[1] 左文述[1] 王永胜[1] 

机构地区：[1]山东省肿瘤防治研究院乳腺疾病中心,济南250117

出　　处：《中华乳腺病杂志（电子版）》2008年第2期18-21,共4页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨术前淋巴显像在乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中的作用。方法回顾性分析了716例联合术前淋巴显像与术中γ探测仪和蓝染料检测乳腺癌SLNB的结果。结果全组SLNB成功率98.2%(703/716),验证组SLNB的假阴性率16.0%(15/94)。淋巴显像共成功地确定出620例患者(86.6%)的前哨淋巴结(sentinel lymphnode,SLN),并在36例患者(5.0%)中发现了腋窝以外的前哨淋巴结。淋巴显像确定SLN的失败率与原发肿瘤的部位、肿瘤的病理类型和注射同位素到显像的时间无显著相关性(均P>0.05)。注射示踪剂前已进行肿瘤切除活检的患者,其淋巴显像成功率低于未行肿瘤切除活检者;淋巴结转移患者淋巴显像的成功率低于淋巴结阴性患者。术中确定SLN的成功率在术前淋巴显像成功组和失败组之间存在显著的统计学差异(99.5%vs91.0%,P<0.01)。术前淋巴显像是否成功确定SLN与SLNB的假阴性率无显著相关性(P=0.731)。结论乳腺癌SLN术前淋巴显像可以预测术中SLNB的成功率,同时术前淋巴显像有助于确定腋窝以外的SLN,但术前淋巴显像并非乳腺癌SLNB所必需。Objective To explore the role of lymphoscintigraphy in sentinel lymph node biopsy （SLNB） in breast cancer patients. Methods We retrospectively analyzed 716 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB in our database. Results The success rate of sentinel lymph node biopsy （SLNB） was 98.2% （703/716）. The false negative rate of SLNB was 16.0% （15/94）. Among all the patients, sentinel lymph nodes （SLN） were well imaged by lymphoscintigraphy in 86.6% patients, and SLNs were found at extra-axilla in 36 patients. The visualization of SLN in lymphoscintigraphy was not associated with histopathologic type, the location and stage of primary tumor and time interval from injection of radiocolliod to surgery. However, the negative lymphoscintigraphy results were associated with excision biopsy before injection of radiocolliod and axillary node metastases. Failure of surgical identification of axillary SLN was associated with the imaging of hot spot by lymphoscintigraphy. There was no significant difference in the false negative rate between patients who had axillary hot spot in lymphoscintigram and those who did not have （P=0.731）. Conclusions Visualization of SLN in preoperative lymphoscintigraphy predicts the successful SLN identification, Moreover, preoperative lymphoscintigraphy is helpful in identification of extra-axillary sentinel nodes. However,it is not necessary in sentinel lymph nodes biopsy in breast cancer.

关 键 词：乳腺肿瘤 前哨淋巴结活检 淋巴显像 

分 类 号：R737.9[医药卫生—肿瘤]