乳腺癌前哨淋巴结周围组织取样病检对降低前哨淋巴结活检假阴性率的临床意义  

Clinical value of sentinel lymph node biopsy combined with surrounding lymph node sampling in reducing false negative rate in breast cancer

作　　者：韩超[1,2] 杨奔[2] 左文述[2] 刘岩松[2] 郑刚[2] 杨莉[2] 郑美珠[2] 

机构地区：[1]济南大学·山东省医学科学院医学与生命科学学院,山东济南250022 [2]山东省肿瘤医院外二科病区,山东省乳腺病防治中心,山东济南250117

出　　处：《中华肿瘤防治杂志》2015年第16期1287-1291,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：中国前哨淋巴结活检多中心协作研究项目(CBCSC-001)

摘　　要：目的探讨乳腺癌前哨淋巴结（sentinellymphnode，SLN）周围组织取样病检对降低前哨淋巴结活检（SLNbi—opsy，SLNB）假阴性率的意义，同时探讨“跳跃转移”现象对SLNB假阴性率的影响。方法对2012-03—01—2015-06—30山东省肿瘤医院596例乳腺癌患者采用染料核素联合法示踪SLN，取出SLN后，在不破坏组织解剖结构的情况下，钝性分离并摘除以SLN为中心，直径3～5cm范围肉眼可见的淋巴结及疑似的淋巴结，并将其定义为SLN周围淋巴结，最后行腋窝淋巴结清除术（axillarylymphnodedissection，ALND），将SLN、SLN周围淋巴结和腋窝其余的淋巴结送病理检查，分析SLN、SLN周围淋巴结及腋窝淋巴结（axillarylymphnode，ALN）转移的相关性。结果596例患者SLN示踪成功率为95．1％（567／596），ALN转移率为33．7％（191／567），单纯SLNB假阴性率为9．9％（19／191），将SLN与SLN周围淋巴结合并，其假阴性率为4．2％（8／191），合并后假阴性率的降低差异有统计学意义，P=0．028；按SLN检出个数（n）将入组患者分为n=1，2，3和≥4共4组，假阴性率分别为19．6％、9．8％、7．3％和2．3％，4组之间假阴性率差异有统计学意义，P=0．049；对于SLN检出个数≤3枚的患者，通过SLN周围淋巴结清除后假阴性率的降低差异有统计学意义（12．2％vs4．7％，P=0．021），而SLN检出个数≥4枚的患者，假阴性率的降低差异无统计学意义，P=1．000。入组患者“跳跃转移”发生率为2．52％（15／596），由“跳跃转移”引起的假阴性率占2．09％（4／i91）。结论SLNB的假阴性率与SLN的检出数目相关，对于检出≤3枚SLN的患者，摘除SLN周围组织内淋巴结可将SLNB的假阴性率降至5％以下的可接受水平；由于“跳跃转移”及“转移个体化现象”的存在，SLNB假阴性率不可能完全消除。OBJECTIVE To explore the meaning of sampling surrounding tissue of sentinel lymph nodes（SLN） for reducing false negative rate of SLN biopsy（SLNB） and the phenomenon of ＇skip metastasis＇ on the influence of false negative rate of SLNB. METHODS Totally 596 patients were checked using radiocolloid combined with methylene blue dye tracer SLNs. SLNs were removed first, and then the suspicious lymph nodes in a range of 3-5 cm around SLNs were removed without destroying peripheral vascular and nerves, axillary lymph node dissection （ALND） or level Ⅰ and Ⅱ dissec- tion were performed last. The SLNs, suspicious lymph nodes and the rest of axillary lymph nodes （ALNs） were patho- logically examined. The correlation of metastasis in these three groups were analyzed. RESULTS The identification rate of 596 patients was 95.1%（567/596）,the metastasis rate of ALNs was 33.7%（191/567）, the false negative rate of SL- NB was 9.9% （19/191） ,in 11 cases of 19 false negative patients the lymph nodes from surrounding tissues were detected metastasis, incorporating SLNs and suspicious lymph nodes together, the false negative rate was 4.2 % （8/191）. The rate of decline showed a significant difference （P=0. 028）. The patients were divided into 4 groups of n=1,2,3 and ≥4 ac cording to the number of detected SLNs. The false negative rate was 19.6%,9.8%,7. 3% and 2.3% respectively, The difference is statistically significant （P=0. 049）. After suspicious lymph nodes clearing, the false negative rate of decline for n≤3 group showed a significant difference（12.2% vs 4.7%; P=0. 021）, and n≥4 group had no statistical significance （P=1. 000）. In this study, the ‘skip metastasis＇ rate was 2.52% （15/596）,the false negative rate which ＇skip metastasis＇ caused was 2.09%. CONCLUSIONS False negative rate of SLNB is related to the number of detected SLNs, expanding dissection of surrounding tissue of SLNs can make the false negative rate of SLNB reduce to less than 5 % of the accepta

关 键 词：乳腺肿瘤 前哨淋巴结活检 前哨周围淋巴结 假阴性率 跳跃转移 

分 类 号：R737.9[医药卫生—肿瘤]