应用γ探测仪探测乳腺癌前哨淋巴结的临床价值  

Clinical application and significance of sentinel lymph node biopsy in breast cancer

作　　者：聂磊[1] 李荣[2] 贾宝庆[2] 张锦明[3] 王培杰[4] 王新国 

机构地区：[1]解放军第八十八医院普外科,泰安271000 [2]解放军总医院普外科 [3]解放军总医院核医学科 [4]解放军第八十八医院病理科,泰安271000

出　　处：《中华核医学杂志》2002年第3期149-150,共2页Chinese Journal of Nuclear Medicine

摘　　要：目的　探讨应用γ探测仪探测乳腺癌前哨淋巴结活组织检查 (SLNB)的临床价值。方法　 5 3例乳腺癌患者 ,在肿块或活组织检查腔周围的乳腺实质内注射99Tcm 硫胶体 ,应用γ探测仪术中定位切除放射性浓聚的前哨淋巴结 (SLN) ,再行腋窝淋巴结清扫 (ALND)。SLN与腋窝淋巴结(ALN)同时行HE和免疫组织化学 (IHC)检测 ,以及用逆转录多聚酶链反应 (RT PCR)检测CK19mRNA的表达 ,观察SLN的检出率和用SLN预测ALN转移的准确性 ,评价SLN阴性的早期乳腺癌患者用SLNB代替ALND的可行性。结果　SLN检出灵敏度为 91% (4 8/ 5 3例 ) ,共检出SLN 91枚 ,平均 1.9枚。SLN预测ALN转移准确性为 10 0 % ,阳性预测值为 0。结论　术中用γ探测仪进行乳腺癌SLNB是可行的 ,SLN可预测腋窝其余淋巴结的转移情况 ,并可作为早期乳癌患者用SLNB代替ALND的可靠指标。Objective To discuss the feasibility, accuracy and clinical value of sentinel lymph node (SLN) biopsy (SLNB) in the management of breast cancer. Methods 99 Tc m labeled sulfur colloid was injected into the breast tissue adjacent to the primary tumor or resection cavity. After 2～4 h, the patients underwent intraoperative lymphatic mapping using a hand-held gamma detector. The SLN was identified and removed, followed by a definitive cancer operation, including an axillary lymph node (ALN) dissection (ALND). The predictive value of sentinel node for the axillary tumor status was evaluated with histopathology, immunohistochemistry (IHC) and RT-PCR. Results The SLN was identified in 48(91%) of patients using this method, altogether 91 SLNs were harvested, an average of 1.9 SLNs was examined and 14.2 ALNs was removed. SLNB was 100% predictive of axillary status in this 48 patients. Conclusion The study confirms that intraoperative lymphatic mapping using a hand-held gamma detector to identify SLN is technically feasible and the histologic characteristics of the SLN probably reflect the histologic characteristics of the rest of the ALNs and SLNB may become a substitute for ALND.

关 键 词：Γ探测仪 乳腺癌 前哨淋巴结 临床价值 肿瘤转移 放射性核素显像 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]