哨兵淋巴结活检对预测乳腺癌腋窝淋巴结转移的价值  

Sentinel lymph node biopsy in breast cancer: value for predicting the statuts of axillary node

作　　者：苏逢锡[1] 贾渭娟[1] 李海刚[2] 曾韵洁[2] 陈积圣[1] 

机构地区：[1]中山医科大学孙逸仙纪念医院乳腺肿瘤外科,广州510120 [2]中山医科大学孙逸仙纪念医院病理科,广州510120

出　　处：《中华外科杂志》2000年第10期784-786,共3页Chinese Journal of Surgery

基　　金：广东省科委攻关资助项目 !(99M0 4914G)

摘　　要：目的　评估哨兵淋巴结 (SN)活检对预测乳腺癌腋窝淋巴结 (LN)转移的价值。　方法　本组 5 2例原发乳腺癌患者 ,临床及B超检测腋窝LN阴性。术中在原发肿瘤周围注射亚甲蓝进行腋窝淋巴结定位和哨兵淋巴结切除 (SLND) ,随后行腋窝淋巴结清扫 (ALND)。术中对部分SN、术后对全部LN(SN和非SN)行常规病理检查。　结果　 5 2例患者中 46例检测到SN ,成功率为 88 5 % ;其中44例 ( 95 7% )的SN可以准确预测腋窝淋巴结转移状态 ;假阴性率为 4 3 %。SLND总的敏感性是90 9% ,特异性是 10 0 % ,总的阳性和阴性预测值分别是 10 0 %和 92 3%。SN是唯一被证实的肿瘤转移LN占 75 0 % ( 15 / 2 0 )。　结论　应用亚甲蓝淋巴定位方法进行的SLND 。Objective[WT5”BZ] To evaluate feasibility and accuracy of intraoperative lymphatic mapping with sentinel lymphadenectomy(SLND) for predicting axillary status in patients with breast cancer. Methods Our study enrolled 52 patients with primary breast cancer, clinically and ultrasonographically negative axillae. Mapping procedures and SLND were performed using methylene blue injected at the primary breast cancer site followed by axillary lymph node dissection(ALND). Sentinel node(SN)was examined by using frozen sections intraoperatively and all of the axillary lymph nodes were evaluated pathologically (HE) after operation. ResultsSentinel nodes were identified in 46(88 5%) of 52 procedures and nodal status accurately predicted axillary in 44 (95 7%) of 46 cases. In 2 (4 3%) of 46 cases, the SN was false negative. The overall sensitivity of the SN technique was 90 9%,with a specificity of 100%. The overall positive and negative predictive values were 100% and 92 3%, respectively. In 15(75%) of 20 cases of clinically negatively and pathologically positive axillary, the SN was the only tumor involved lymph node identified. Conclusion Our study indicates that intraoperative lymphatic mapping using a vital dye and SLND can accurately predict the axillary stutas of primary breast cancer patients with clinically and ultrasonographically negative axillae.

关 键 词：乳腺癌 哨兵淋巴结活检 SN 腋窝淋巴结转移 

分 类 号：R737.9[医药卫生—肿瘤]