降低乳腺癌前哨淋巴结活检假阴性率的探讨  

How to reduce the false negative rate of sentinel lymph node biopsy on breast cancer

作　　者：张涛[1] 陈保平[1] 王洪[1] 富鹰[1] 魏希亮[1] 李中[1] 胡庚坤[1] 

机构地区：[1]河北大学附属医院肿瘤外科,保定071000

出　　处：《肿瘤》2008年第5期443-445,共3页Tumor

摘　　要：目的:探讨应用放射性示踪剂进行乳腺癌前哨淋巴结(sentinel lymph node,SLN)活检时出现假阴性的原因,探索降低假阴性率的方法。方法:收集2000年5月—2007年5月进行乳腺癌SLN活检150例,术前注射99mTc标记的右旋糖酐(99mTc-DX),术中应用γ探测仪进行SLN探测,术后将SLN单独送检进行病理学检查。结果:SLN活检的成功率为96%,灵敏度为93.4%,特异度为100%,假阴性率为6.6%,假阳性率为0,准确度为97.2%,阳性结果预测值为100%,阴性结果预测值为95.4%,尤登指数(正确指数)为0.934。假阴性与适应证的选择、解剖变异、术前活检和放疗、内乳SLN的出现、多灶性病变、病理学检查不彻底、探测技术不熟练有关。结论:严格掌握SLN活检适应证,严格按标准的操作规程进行探测,术中仔细认真,术后对SLN进行详细的病理学检查,可以逐步将假阴性率降低到可接受的程度。Objective ： To investigate the reasons for false negative test results of sentinel lymph node （SLN） biopsy using isotope for patients with breast cancer and discuss how to reduce the false negative rate. Methods：The SLNs were identified in 150 breast cancer patients between May 2000 and May 2007. ^99mTc-labeled dextran （^99mTc-DX） was injected pre-operatively, then the localization of SLN was identified by γ-detecting probe intraoperatively, finally the removed SLNs were confirmed by routine pathological examination. Results：The detection rate of SLN biopsy was 96%. The sensitivity, specificity, false negative rate, false positive rate, and accuracy of SLN detection were 93.4% , 100% , 6.6% , 0% , and 97.2% , respectively. The positive and negative predictive value were 100% and 95.4% , respectively. Youden＇ s index was 0. 934. The false negative rate was associated with the selection of indication, anatomic variation, preoperative biopsy and radiotherapy, appearance of internal mammary SLN, muhifocality, incomplete pathological examination and inexperienced skills. Conclusion：The false negative rate could be reduced to an acceptable degree gradually by strictly selecting indications for SLN biopsy, probing SLN location according to standard operating procedure, keeping seriousness, performing postoperative pathological examination.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 假阴性反应 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]