多点注射亚甲蓝联合超声在乳腺癌前哨淋巴结活检术中的应用价值  

Application of methylene blue injection at multiple points combined with ultrasound in sentinel lymph node biopsy of breast cancer

作　　者：徐玉瑞[1] 伏钢[2] 郝厉红 巢琳[1] 何旻[1] 孙永宏[1] 李琛[1] XU Yurui;FU Gang;HAO Lihong;CHAO Lin;HE Min;SUN Yonghong;LI Chen(Department of Breast and Thyroid,the Second People's Hospital of Wuxi Affiliate to Nanjing Medical University,Wuxi 214002,China;Department of Ultrasound,the Second People's Hospital of Wuxi Affiliated to Nanjing Medical University,Wuxi 214002,China)

机构地区：[1]南京医科大学附属无锡第二人民医院甲乳外科,江苏无锡214002 [2]南京医科大学附属无锡第二人民医院超声科,江苏无锡214002

出　　处：《中华实用诊断与治疗杂志》2020年第11期1106-1109,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：福建省卫生和计划生育委员会青年科研课题(2014-1-13)。

摘　　要：目的比较乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)中亚甲蓝单点注射、亚甲蓝多点注射联合超声对前哨淋巴结的诊断价值。方法行乳腺癌改良根治术或保乳术患者46例,术中均行SLNB,其中23例行亚甲蓝多点注射联合超声SLNB者为超声组,23例行亚甲蓝单点注射SLNB者为对照组。超声组SLNB根据前哨淋巴结超声声像特征及术中临床特点预测阳性前哨淋巴结,对照组SLNB根据前哨淋巴结术中临床特点预测阳性前哨淋巴结。比较2组SLNB前哨淋巴结检出率及平均检出数;以组织病理结果为金标准,比较2组SLNB诊断阳性前哨淋巴结的价值。结果超声组SLNB检出22例65枚前哨淋巴结,1例SLNB失败;对照组SLNB检出21例44枚前哨淋巴结,2例SLNB失败;2组前哨淋巴结检出率比较差异无统计学意义(P>0.05),超声组前哨淋巴结检出数[(2.82±1.11)枚]多于对照组[(1.91±1.00)枚](P<0.05)。以组织病理结果为金标准,超声组SLNB阳性前哨淋巴结31枚,阴性34枚;对照组SLNB阳性前哨淋巴结25枚,阴性19枚;超声组诊断前哨淋巴结转移的准确率及阴性预测值(75.38%、88.24%)高于对照组(56.82%、47.37%)(P<0.05),灵敏度、特异度、阳性预测值与对照组比较差异均无统计学意义(P>0.05)。结论亚甲蓝多点注射联合超声行SLNB可合理利用注射示踪剂后术中等待时间,提高乳腺癌患者前哨淋巴结检出数,对排除前哨淋巴结转移具有较高价值。Objective To compare the value of methylene blue injection at one point in sentinel lymph node biopsy(SLNB)versus methylene blue injection at multiple points in SLNB combined with ultrasound to the diagnosis of sentinel lymph node(SLN)metastasis of breast cancer.Methods In 46patients with breast cancer undergoing SLNB in modified radical mastectomy or breast-conserving surgery,23patients received methylene blue injection at multiple points combined with ultrasound(ultrasound group),and another 23breast cancer patients received methylene blue injection at only one point and no lymph node ultrasound(control group).The SLN metastasis was predicted by ultrasound and intraoperative findings in ultrasound group,and by intraoperative findings in control group.The detection rate and average detection number were compared between two groups.Taking the pathological result as the gold standard,the diagnostic value of SLNB on positive SLN was compared between two groups.Results A total of 65SLNs from 22patients were detected and 1patient failed SLNB in ultrasound group,and 44SLNs were detected from 21patients and 2patients failed SLNB in control group.The detection rate showed no significant difference between two groups(P>0.05).The average count of detected SLNs was greater in ultrasound group(2.82±1.11)than that in control group(1.91±1.00)(P<0.05).Thirty-one positive SLNs and 34negative SLNs were predicted in ultrasound group,and 25positive SLNs and 19negative SLNs were predicted in control group.The accuracy and negative predictive value were higher in ultrasound group(75.38%,88.24%)than those in control group(56.82%,47.37%)(P<0.05).The sensitivity,specificity and positive predictive value showed no significant differences between two groups(P>0.05).Conclusion Intraoperative ultrasound combined with methylene blue injection at multiple points in SLNB can make good use of the time after injecting tracer and can increase the detected SLNs count,and it has a high diagnostic value in excluding SLN metastasis.

关 键 词：乳腺癌 前哨淋巴结活检术 超声 亚甲蓝 

分 类 号：R737.9[医药卫生—肿瘤]