乳腺癌前哨淋巴结活检的初步体会  

Preliminary Experience of the Value of Setinel Node Biopsy in Breast Cancer Operations

作　　者：吴萍[1] 王建军 杨勇 朱健 翁志毅 

机构地区：[1]上海第二医科大学附属新华医院普外科

出　　处：《中国现代手术学杂志》2001年第4期262-264,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的　初步探讨乳腺癌前哨淋巴结 (sentinellymphnode ,SLN )检测的可行性 ,SLN预测腋窝淋巴结状态的可靠性。　方法　对我院普外科收治的 15例T1～ 2 期、腋窝未扪及肿大淋巴结的乳腺癌病人 ,使用99mTc右旋糖酐或99mTc硫胶体为示踪剂 ,γ探测仪探测SLN ,然后进行活检和腋窝淋巴结清扫 (axillarylymphnodedissection ,ALND) ,两处标本同时送病理检查 ,以此来评价SLN的病理组织学结果能否准确地反映腋窝淋巴结状态。　结果　在 10例病人中发现SLN ,发现率为 6 6 .6 % ( 10 /15 )。SLN的数量为 1～ 3枚 /例 ,平均 2 .1枚 /例。非前哨淋巴结 (non sentinellymphnode ,NSLN) 5～ 16枚 /例 ,平均 10 .3枚 /例。发现SLN的 10例病人中 1例 ( 10 % )SLN有癌转移 ,其他腋窝淋巴结未见转移 ;2例SLN未发现癌转移而NSLN有癌转移 ,假阴性率 2 0 % ( 2 /10 ) ,准确性 80 % ( 8/10 )。　结论　乳腺癌前哨淋巴结定位和活检技术以及预测腋窝淋巴结状态的可靠性方面有待进一步积累经验 ,提高准确性 ,降低假阴性率。Objective To estimate the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer, and to examine the accuracy of SNB for prediction of the status of patient's axillary lymph nodes. Methods Since July 2000 fifteen patients with breast cancer less than 5 cm in diameter and clinical negative axillary node had underwent SNB. After injection of standard 99m Tc-Dextran or 99m Tc sulphur colloid around the tumor, biopsy was made at the location detected by γ probing. The samples of SLN and ALN were sent for histological examination. Results The sentinel nodes were identified in 66.6% (10/15) of the patients, with an average of 2.1(1～3) nodes excised in the axillary lymph node dissection(ALDN). The non-sentinel lymph nodes (NSLN) excised down averaged 10.3(5～16). The pathological results showed NSLN positive but SLN negative in 2 patients, yielding an accuracy of 80%. Conclusions For predicting the status of axillary node, further experience of lymphatic mapping and sentinel node biopsy is needed to decrease the false negative rate.

关 键 词：乳腺肿瘤 前哨淋巴结 前哨淋巴结活检 诊断 淋巴结转移 

分 类 号：R737.9[医药卫生—肿瘤]