同位素示踪前哨淋巴结活检在预测乳腺癌腋窝淋巴结转移中的应用  

Application of sentinel lymph nodes biopsy by isotope in predicting status of axillary nodes of breast cancer patients

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

机构地区：[1]河北大学附属医院,河北保定071000

出　　处：《山东医药》2008年第24期7-9,共3页Shandong Medical Journal

基　　金：河北省医学科学研究重点课题计划(07135)

摘　　要：目的探讨前哨淋巴结(SLN)能否反映腋窝淋巴结的转移状况及该技术在临床中的应用。方法乳腺癌患者150例,在肿瘤周围表面皮肤上均匀地选取4点,每点皮内注射99m锝标记的右旋糖酐(99mTc-DX)进行乳腺癌前哨淋巴结活检(SLNB),术中用γ探测仪进行定位,SLNB后行改良根治术或保乳手术,对SLN单独送检并进行详细的病理学检查。结果成功进行SLNB144例,成功率为96.0%,每例检出SLN1～4个,所有SLN均位于腋窝第一水平,SLNB的灵敏度为93.4%,特异度为100.0%,假阴性率为6.6%,假阳性率为0,准确性为97.2%,阳性结果预测值为100%,阴性结果预测值为95.4%,尤登指数为0.934。进行免疫组化染色的59例SLN中,共发现14例微小转移,但14例中非SLN未见微小转移。结论SLN可以反映腋窝淋巴结的转移情况,可以指导临床决定是否需行腋窝清扫,同位素示踪法进行SLNB具有操作简单、准确性高等优点。Objective To study the possibility of sentinel lymph nodes（SLN） accurately predicting the status of axillary nodes of breast cancer patients and the application of SLN biopsy in clinical practice. Methods In 150 breast cancer patients, the SLN identified by 99m^Tc-DX were excised for biopsy by using a hand - held - γ- detection probe in operation, after SLN biopsy, modified mastectomy or breast - conserying therapy was followed. The SLNs were examined separately and in detail by pathologist. Results SLNs were identified in 144 patients, the successful rate was 96.0%. The number of SLNs were 1 - 4 in every patient. All SLNs were located at level I of axillary. The sensitivity of SLN biopsy was 93.4%, the specificity was 100.0% ,the false negative rate was 6.6%, the false positive rate was 0, the accuracy rate was 97.2%, the positive predictability was 100.0%, the negative predictability was 95.4%, Youden＇s index was 0. 934. The SLNs of 59 cases were examined by immunohistochemical staining, 14 cases were found micrometastases, but its were not found in their non - SLNs. Conclusions SLN can evaluate the status of axillary lymph nodes in breast cancer patients and determine whether the axiUary dessection is done. The method of SLN identified by isotope has many advantages of simplicity, high accuracy, etc.

关 键 词：乳腺肿瘤 放射性核素成像 前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]