术前淋巴显像在乳腺癌前哨淋巴结活检术中的价值  

Value of preoperative lymphoscintigraphy in sentinel lymph node biopsy of breast cancer

作　　者：孙晓[1] 刘娟娟[2] 王永胜[1] 王磊[1] 杨国仁[2] 周正波[1] 李永清[1] 刘雁冰[1] 李太玉[1] 

机构地区：[1]山东省肿瘤医院乳腺病中心,山东济南250117 [2]山东省肿瘤医院核医学科,山东济南250117

出　　处：《中国实用外科杂志》2010年第9期783-786,共4页Chinese Journal of Practical Surgery

基　　金：中国抗癌协会乳腺癌专业委员会CBCSG-001项目子项目

摘　　要：目的探讨术前淋巴显像在乳腺癌前哨淋巴结活检术(SLNB)中的价值。方法前期回顾性分析山东省肿瘤医院2000年9月至2007年6月接受SLNB的716例乳腺癌病人的资料,所有病人均行术前淋巴显像;后期的前瞻性研究共入组山东省肿瘤医院2007年7月至2009年11月接受SLNB的565例乳腺癌病人,随机分为术前淋巴显像组和不行淋巴显像组。结果回顾性研究术前淋巴显像成功率为86.6%,只与术后腋淋巴结病理状况显著相关(P=0.003);术前腋窝淋巴显像成功与失败组间核素法SLNB成功率的差异有统计学意义(P<0.001),但核素法SLNB假阴性率、联合法SLNB成功率及假阴性率的差异均无统计学意义(分别P=0.731,P=0.174,P=0.947)。前瞻性研究术前淋巴显像组(82.1%显像成功)和不行淋巴显像组核素法SLNB成功率及假阴性率、联合法SLNB成功率及假阴性率的差异均无统计学意义(分别P=0.757,P=1.00,P=1.00,P=1.00)。结论术前淋巴显像既不能提高SLNB的成功率,也不能降低其假阴性率,临床实践中乳腺癌SLNB术前可以不行淋巴显像;术中联合使用蓝染料和γ探测仪同样可以准确进行SLNB。Objectives Background Although preoperative lymphoscintigraphy for sentinel lymph nodes biopsy （SLNB） in breast cancer patients is undergone commonly, its clinical significance remains controversial. Methods Firstly, a database containing 716 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB was retrospectively analyzed. Secondly, 565 consecutive breast cancer patients were prospectively randomized into groups with or without preoperative lymphoscintigraphy before SLNB. Results In the retrospective study, sentinel lymph nodes （SLNs） were well imaged by lymphoscintigraphy in 86.6% patients, and negative lymphoscintigraphy results were associated with axillary node metastases. Failure of identification of SLNs by isotope alone was associated with whether axillary hot spot was imaged by lymphoscintigram （P0.001）. There were no significant differences in the false negative rate （P=0.731） of SLNB by isotope alone, in the identification rate （P=0.174） and the false negative rate （P=0.947） of SLNB by combination of dye and isotope between patients who had axillary hot spot in lymphoscintigram and those who had not. In the prospective study, 290 patients were randomized into the group with preoperative lymphoscintigraphy （82.1% patients were well imaged by lymphoscintigraphy） and 275 patients without. There were no significant differences between two groups in the identification rate （P=0.757） and the false negative rate （P=1.00） of SLNB by isotope alone, also in the identification rate （P=1.00） and the false negative rate （P=1.00） of SLNB by combination of dye and isotope. Conclusion Preoperative lymphoscintigraphy could not improve the identification rate and reduce the false negative rate of SLNB in breast cancer patients, and it is not a prerequisite for SLNB.

关 键 词：乳腺癌 前哨淋巴结活检术 淋巴显像 

分 类 号：R6[医药卫生—外科学]