早期乳腺癌前哨淋巴结活检联合腋窝淋巴结取样126例应用报告  

Application of sentinel lymph node biopsy combined with axillary lymph node sampling in 126 patients with early breast cancer

作　　者：谢竞[1] 霍彦平[1] 赵晓燕[1] 高峰[1] 郝红军[1] 

机构地区：[1]郑州大学附属郑州中心医院乳腺外科,河南郑州450007

出　　处：《中国妇幼保健》2015年第21期3729-3731,共3页Maternal and Child Health Care of China

基　　金：郑州市2013年度科技发展计划项目〔20130597〕

摘　　要：目的探讨亚甲蓝示踪前哨淋巴结活检（SLNB）联合腋窝淋巴结取样（ALNS）在早期乳腺癌手术中应用的可行性。方法对126例早期乳腺癌患者行亚甲蓝示踪SLNB联合ALNS检查，标本分别标记后送快速冰冻病理检查，活检阳性者进一步行腋窝淋巴结清扫（ALND），术后所有标本均行常规石蜡切片检查，比较SLNB联合ALNS与单纯SLNB法术中评估腋淋巴结状态的差异。结果通过亚甲蓝示踪行SLNB，有5例未找到前哨淋巴结，检出率为96．0％，术中快速冰冻切片检查的准确率为93．7％，敏感性为81．0％，假阴性率为19．0％。SLNB联合ALNS法检出率为100．0％，每例检出淋巴结2～9枚，平均4．1枚，准确率为96．8％，敏感性为90．5％，假阴性率为9．5％。术后常规病理检查发现4例前哨淋巴结有癌转移，1例为孤立肿瘤细胞，3例为微转移，腋窝淋巴结取样未发现癌转移。126例患者中位随访21个月（6—45个月），均未发现腋窝淋巴结复发转移。结论前哨淋巴结活检联合腋窝淋巴结取样操作简单、敏感性高、假阴性率低，更有助于术中评估早期乳腺癌患者腋窝淋巴结的状态，指导术后综合治疗的选择。Objective To explore the application feasibility of sentinel lymph node biopsy （SLNB） using methylene blue dye technique combined with axillary lymph node sampling （ALNS） in patients with early breast cancer. Methods SLNB using methylene blue dye technique combined with ALNS were conducted among 126 patients with early breast cancer, the labeled lymph nodes were submitted for quick frozen section diagnosis respectively. The patients with positive lymph nodes underwent total axillary nodes dissection （ALND）, after surgery, pathological examination of pm＇affin- embedded slides was conducted routinely for all the lymph nodes, the difference of intraoperative node status between SLNB＋ ALNS group and SLNB group was Compared. Results In SLNB group, the sentinel node was not identified in five cases, the detected rate was 96.0%, the accuracy rate of intraoperative quick frozen section diagnosis was 93.7%, the sen- sitivity was 81.0%, the false negative rate was 19.0%. The detected rate of SLNB combined with ALNS was 100. 0%, the mean number of lymph nodes removed was 4. 1 （ ranging from 2 to 9）, the accuracy rate was 96. 8%, the sensitivity was 90. 5%, the false negative rate was 90. 5%. Durinz routine Datholozical examination after surzerv, cancerometastasis of sentinel nodes w,s fnunt in fnur n, tianta in,AnAin nnapatient of isolated tumor cell and three patients of micrometastases, no cancerometastasis was found by ALNS; after a median follow- up period of 21 months （ranging from 6 to 45 months）, no recurrenceand metastasis of axillary lymph node was found. Conclusion SLNB combined with ALNS has the advantages of simple operation, high sen- sitivity and low false negative rate, which can improve the accuracy of evaluation of the intraoperative axillary nodes in patients with early breast cancer and guide the comprehensive treatment after surgery.

关 键 词：乳腺肿瘤 前哨淋巴结活检 腋窝淋巴结取样 

分 类 号：R737.9[医药卫生—肿瘤]