蓝染法联合核素示踪法在早期乳腺癌前哨淋巴结活检术中的应用及临床分析  

Application and clinical analysis of methylene blue combined with nuclide tracing method in the sentinel lymph node biopsy of early breast cancer

作　　者：张晨光[1] 雪来提.派祖拉 伊丽娜[1] 蒋威华[1] 欧江华[1] ZHANG Chen-Guang Xuelaiti · Paizula YI Li-Na JIANG Wei- Hua OU Jiang-Hua(Department of Breast Surgery Ward 1I, Tumor Hospital Affiliated of Xinjiang Medical University, Urumuqi 830011, China)

机构地区：[1]新疆医科大学附属肿瘤医院乳腺外科二病区,新疆乌鲁木齐830011

出　　处：《转化医学电子杂志》2017年第6期29-35,共7页E-Journal of Translational Medicine

基　　金：新疆医科大学创新基金(XYDCX201477)

摘　　要：目的:探讨早期乳腺癌前哨淋巴结活检术(SLNB)的可行性及其对腋窝淋巴结分期的预测情况,比较蓝染法与联合法对前哨淋巴结(SLN)的检出率以及患者的临床特征对SLN检出率的影响.方法:回顾性分析2015-07-21/2016-08-25新疆医科大学附属肿瘤医院乳腺外科所实施的190例SLNB患者的临床资料.所有患者中,134例采用放射性核素联合美蓝染色示踪法定位SLN,其余56例采用美蓝染料注射法.如SLN阳性,则继续行腋窝淋巴结清扫术(ALND),如SLN阴性,则根据患者意愿以及其具体情况选择是否行ALND,即"保腋窝".结果:190例乳腺癌SLNB患者中,成功检出188例,2例未检出,8例假阴性,检出率为98.9%,准确率为94.6%,假阴性率为11.6%.结论:SLNB能准确预测腋窝淋巴结的状态,蓝染法和联合法示踪SLN均能够准确定位SLN,可根据情况选择示踪方法.年龄因素对SLN的检出率及假阴性率有明显影响,施行过程中对年龄≥50岁的患者应尽量采用联合法检测SLN.病灶部位、病灶大小、核素注射部位、病理类型等因素对SLN检出率及假阴性率均无明显影响.AIM： To discuss the feasibility of sentinel lymph node biopsy （SLNB） of early breast cancer and the ability of SLNB for predicting axillary lymph node stage, then analyze the effect of methylene blue method and methylene blue combined with nuclide tracing method and clinical features on the detection rate of sentinel lymph node（SLN）. METHODS： A retrospective study was conducted to analyze 190 cases of breast cancer under- went SLNB in the Department of Breast Surgery, Affiliated Tumor Hospital, Xinjiang Medical University. Of all the patients, a total of 134 cases were received sentinel lymph node mapping with methylene blue combined with nuclide tracing method, while the remaining cases were received sentinel lymph node mapping with methylene blue method. If the SLN was positive, the axiUary lymph node dissection （ALND） was performed; if it was nega- tive, whether the ALND was carried out according to the specific condition of patients and their wishes. RESULTS： Of all the patients with SLNB, SLN were found successfully in 188 patients, only 2 patients were undetectable, with false negative in 8 cases. The detection rate was 98.9%, and the accurate rate was 94.6%, the false negative rate was 11.6%. CONCLUSION： SLNB can predict the condition of axillary lymph nodes, while methylene blue combined with nuclide tracing method can locate the SLN better, and doctor can choose tracing method according to patient＇s situation. The age of patients has obvious effect on the detection rate and false negative rate of SLN, therefore patients over age 50 should try to receive SLN mapping with methylene blue combined with nuclide tracing method. The lesion location, lesion size, injection site of nuclide and pathological type and other factors have no significant effect on the detection rate and false negative rate of SLN.

关 键 词：乳腺癌 前哨淋巴结活检术 腋窝淋巴结清扫术 假阴性 

分 类 号：R737.9[医药卫生—肿瘤]