乳腺癌前哨淋巴结活检30例分析  

Sentinel lymph node biopsy in breast cancer using radiolabeled sulphur colloid

作　　者：尼尔马[1] 沈坤炜[1] 韩企夏[1] 邵志敏[1] 吴炅[1] 陆劲松[1] 张家新[1] 柳光宇[1] 庄传经[1] 沈镇宙[1] 杜会锋 章英剑 

机构地区：[1]复旦大学医学院肿瘤医院乳腺外科,上海200032 [2]复旦大学医学院肿瘤医院核医学科,上海200032

出　　处：《中国癌症杂志》2000年第6期481-484,共4页China Oncology

摘　　要：目的 :以同位素为示踪剂探测乳腺癌前哨淋巴结 (sentinellymphnode ,SLN) ,并根据前哨淋巴结活检和腋淋巴结清扫的病理结果。评价前哨淋巴结预测腋窝淋巴结转移的准确性。方法 :研究对象为自 2 0 0 0年 5月份起我院乳腺科收治的 30例T1— 2 N0 的乳腺癌患者。使用99mTc 硫胶体 (99mTc sulphurcolloid)为示踪剂 ,用Gamma探测仪进行前哨淋巴结探测活检 ,之后行腋窝清扫。结果 :2 7例患者中成功地发现了SLN ,发现率为 90 % (2 7/ 30 ) ,前哨淋巴结的数量为 1— 3个 ,平均每例 1 5个。非前哨淋巴结 (nonsentinelnode) 5— 2 0个 ,平均数 13 3个。 2 7例SNB成功的患者中 14(5 2 % )例有腋窝淋巴结转移。前哨淋巴结未发现转移而非前哨淋巴结有转移的有 2例 ,假阴性率7 4% (2 / 2 7) ,准确性 92 6 % (2 5 / 2 7)。T1乳腺癌无一例假阴性。结论 :使用Gamma探测仪的前哨淋巴结活检能准确的预测腋窝淋巴结转移情况 ,尤其对于早期乳腺癌。Purpose:To evaluate the performance and feasibility of sentinel node biopsy (SNB) in breast cancer patients using 99mTc Sulphur colloid and gamma probe.Methods:At Cancer Hospital,from May 2000 30 patients with tumor less than 5 cm with clinically negative axilla underwent SNB, which is followed by standard axillary dissection. 99mTc sulphur colloid was injected around the breast tumor and gamma probe was used to detect the SLN during surgery. SNB is compared with standard axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes.Results:The sentinel node is successfully identified in 90% (27/30) of the patients. Number of sentinel nodes ranged from 1—3,average 1.5, nonsentinael nodes 5—20,average 13.3 per patient. Of the 27 patients 52%(14/27) were histologically positive. The sentinel node was falsely negative in 2 patients, yielding an accuracy of 92.6%. In T 1 tumors, SNB was more accurate than for T 2 tumors.Conclusions:Gamma probe guided method is technically feasible in detecting sentinel nodes in most cases and predicts the axillary status quite accurately, and appears to be more accurate for T 1 lesions than for larger lesions. This minimally invasive axillary staging procedure represents a major advance in the surgical treatment of breast cancer.

关 键 词：乳腺癌 前哨淋巴结 外科手术 腋窝淋巴结清扫 

分 类 号：R737.9[医药卫生—肿瘤]