乳腺癌内乳区前哨淋巴结活检术对淋巴分期和个体化治疗的影响  

Internal mammary sentinel lymph node biopsy in breast cancer： accurate staging and individualized treatment

作　　者：邱鹏飞[1] 赵荣荣[2] 丛斌斌[1] 杨国仁[3] 刘雁冰[1] 陈鹏[1] 孙晓[1] 王春建[1] 王永胜[1] 

机构地区：[1]山东省肿瘤医院乳腺病中心,济南250117 [2]山东省肿瘤医院内科,济南250117 [3]山东省肿瘤医院核医学科,济南250117

出　　处：《中华肿瘤杂志》2016年第1期42-47,共6页Chinese Journal of Oncology

基　　金：国家自然科学基金（81502314）;山东省自然科学基金（ZR2014HZ003、ZR2015PH025）

摘　　要：目的探讨乳腺癌内乳区前哨淋巴结活检术（IM—SLNB）对淋巴分期和辅助治疗方案的影响。方法前瞻性分析行SLNB的349例乳腺癌患者的临床资料，均经穿刺病理证实为乳腺癌。结合术前淋巴显像和术中叮探测仪定位内乳区前哨淋巴结（IM—SLN），经肋间行IM—SLNB，评估治疗策略改变的情况，分析IM—SLNB的成功率、并发症和学习曲线。结果349例患者中，IM—SLN显像248例（71．1％）。153例接受IM—SLNB的患者中，成功149例，IM—SLNB的成功率为97．4％，胸膜、内乳血管损伤的发生率分别为7．2％和5．2％，IM—SLN的转移率为8．1％（12／149）。行IM—SLNB后，患者的淋巴分期发生改变12例（8．1％），仅使1例（0．7％）系统辅助治疗策略发生改变。8．1％（12／149）的患者可以接受个体化内乳区放疗。结论IM—SLNB成功率高，安全性好，可以为乳腺癌患者提供精确的淋巴分期，并且指导个体化的内乳区放疗策略。Objective The aim of this study was to determine the impact of routinely performed internal mammary sentinel lymph node biopsy （IM-SLNB） on the staging and treatment, and to analyze the success rate, complications and learning curve. Methods All patients with biopsy-proven breast cancer who underwent sentinel lymph node biopsy between 2012 and 2014 were included in a prospective analysis. Internal mammary sentinel lymph node biopsy （IM-SLNB） was performed in all patients with IM-SLN visualized on preoperative lymphoscintigraphy and/or detected by intraoperative gamma probe detection. The adjuvant treatment plan was adjusted according to the current guidelines. Results In a total of 349 patients, 249 patients （71.1%） showed internal mammary drainage. IM-SLNB was performed in 153 patients with internal mammary drainage, with a success rate of IM-SLNB of 97.4% （149/153）. Pleural lesion and internal mammary artery bleeding were found in 7.2% and 5.2% patients, respectively. In 8.1% of patients （12/149） the IM-SLN was tumor positive. In the group of patients who underwent IM-SLNB, lymph node staging was changed in 8.1% of patients, and IMLNs radiotherapy was guided by these results, however, systemic treatment was changed in only 0.7% of the patients. Conclusions IM-SLNB has a high successful rate and good safety. Identification of internal mammary metastases through IM-SLNB may provide more accurate staging and guide the tailored internal mammary radiotherapy. Trial registration ClinicalTrials. gov, NCT01642511

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 肿瘤分期 个体化医学 内乳区 

分 类 号：R737.9[医药卫生—肿瘤]