乳腺肿物局部切除术后乳腺癌前哨淋巴结活检的可行性分析  

Feasibility analysis of sentinel lymph node biopsy in patients with breast cancer after local lumpectomy

作　　者：王杰[1] 王昕[1] 王文彦[1] 刘嘉琦[1] 邢泽宇[1] 王翔[1] 

机构地区：[1]国家癌症中心 中国医学科学院北京协和医学院肿瘤医院乳腺外科,100021

出　　处：《中华肿瘤杂志》2016年第7期548-551,共4页Chinese Journal of Oncology

摘　　要：目的 探讨乳腺肿物局部切除术后乳腺癌前哨淋巴结活检（SLNB）的可行性、安全性和临床应用价值。方法 回顾性分析2005年1月至2015年4月临床病理分期为T1-2N0M0的195例乳腺肿物局部切除术后、行SLNB患者的临床资料，肿物局部切除术至SLNB间隔时间为1-91 d，平均18.3 d；术前肿块直径0.2-4.5 cm，平均1.8 cm。结果 全组195例患者均成功检出前哨淋巴结，检出率为100%。42例患者行腋窝淋巴结清扫，19例患者前哨淋巴结病理检测阳性，准确性为97.6%，灵敏度为95.0%，假阴性率为5.0%，特异度为100%，假阳性率为0。Logistic回归分析结果显示，患者的年龄与局部切除术后前哨淋巴结转移有关。结论 对早期乳腺癌，乳腺肿物活检后选择适当示踪方法，行SLNB仍具有较高的检出率和准确性。Objective To explore the feasibility, safety and clinical application value of sentinel lymph node biopsy（SLNB） in patients with breast cancer after local lumpectomy. Methods Clinical data of 195 patients who previously received local lumpectomy from January 2005 to April 2015 were retrospectively analyzed. All the patients with pathologic stage T1-2NOM0 （TI-2NOM0） breast cancer underwent SLNB. Methylene blue, carbon nanoparticles suspension, technetium-99m-labeled dextran, or in combination were used in the SLNB. The interval from lumpectomy to SLNB was 1-91 days （mean, 18.3 days）and the maximum diameter of tumors before first operation was 0.2-4.5 cm （mean, 1.8 cm）. Results The sentinel lymph node was successfully found in all the cases and the detection rate was 100%. 42 patients received axillary lymph node dissection （ALND） , 19 patients had pathologically positive sentinel lymph node, with an accuracy rate of 97.6%, sensitivity of 95.0%, false negative rate of 5.0%, and specificity of 100%, and the false positive rate was 0. Logistic regression analysis suggested that the age of patients was significantly associated with sentinel lymph node metastasis after local lumpectomy. Conclusions For early breast cancer and after breast tumor biopsy, the influence of local lumpectomy on detection rate and accuracy of sentinel lymph node is not significant. Sentinel lymph node biopsy with appropriately chosen tracing technique may still provide a high detection rate and accuracy.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 可行性研究 肿物局部切除术 

分 类 号：R737.9[医药卫生—肿瘤]