联合法观察前哨淋巴通道的临床研究  

The study on sentinel lymphatic channels by using methylene blue and technetium 99m sulfur colloid in breast cancer patients

作　　者：王水[1] 刘晓安[1] 赵佳[1] 耿强[1] 刘力嘉[1] 

机构地区：[1]南京医科大学第一附属医院普外科乳腺内分泌病区,210029

出　　处：《中华乳腺病杂志（电子版）》2007年第1期35-38,共4页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：江苏省科技发展计划(社会发展)基金资助项目(BS2004040)

摘　　要：目的通过乳晕下联合注射^(99)Tc^m-SC和美蓝,研究前哨淋巴通道(SLC)的行走方向、途径、数量及其与前哨淋巴结(SLN)之间的关系,以探讨乳腺癌SLNB出现假阴性的机制,并提出提高其检出率、减少假阴性的方法。方法 93例Ⅰ～Ⅱ期乳腺癌患者行术前核素法SLC显像和术中染料法SLC显像,并据SLC行前哨淋巴结活检(SLNB)。结果 93例中核素法和染料法同时成功显示SLC和SLN者81例。大多数患者只有一条位于乳腺外上象限的SLC,且主要集中在θe角为31°～90°的范围内,均终止于腋窝SLN。沿SLCs解剖出的SLN,病理结果未发现有假阴性和假阳性。结论尚未发现乳腺癌腋窝"跳跃式"淋巴转移模式,推测SLNB假阴性的产生是技术问题,可能与手术者对SLCs和SLN行走路线和数量的复杂性认识不足有直接关系。核素法与染料法各有优劣,两者联合,优势互补,通过术前核素显像对SLC和SLN的分布获得大致了解后,在术中仔细解剖沿蓝染SLC寻找SLN,可以有效的检出SLC,并减少SLNB的假阴性率。Objective The objective of this study was to define the direction, route and number of sentinel lymphatic channels （SLCs） and their relationship with sentinel lymph node （SLN） after subareolar injection of methylene blue and technetium 99m sulfur colloid （99Tcm-SC）, as well as to explore why senti- nel lymph node biopsies （SLNB） produce false negative results in breast cancer patients. Methods 99Tcm- SC was injected preoperatively, and methylene blue was injected by the same subareolar route just after anes- thetic induction, then SLNB was carried out according to SLCs in 93 breast cancer cases （ stage Ⅰ - Ⅱ ）. Results SLCs and SLN were identified by using both methylene blue and 99Tcm-SC in 81 cases successful- ly. In most cases, a single SLC exited the areola, traveled through the upper, outer quadrant and terminated at an axillary SLN. No false negative or false positive was demonstrated by pathological ananlysis of SLN which was identified according to SLCs. Conclusions No evidence showed that the mechanism of axillary lymph node metastasis is skip metastasis. We conclude that false negative results from SLNB seems to be associated with the technique used, which may be caused by the incomplete knowledge of the anatomical relationship between SLCs and SLN. By combining use of subareolar injection of methylene blue and 99Tcm-SC, SLCs and SLNs can be identified preoperatively and dissected carefully during operation. The detection rate of SLCs can be improved and the false negative rate of SLNB can be reduced.

关 键 词：乳腺癌 前哨淋巴结活检 前哨淋巴通道 99Tcm-SC 美蓝 

分 类 号：R737.9[医药卫生—肿瘤]