超声造影联合金属标记夹定位在乳腺癌新辅助化疗后前哨淋巴结活检中的应用  

Application of contrast-enhanced ultrasonography with placement of marker-clip in sentinel lymph node biopsy of breast cancer after neoadjuvant chemotherapy

作　　者：周毅 蔡仕彬[1] 陈述政[1] 冯娅琴[1] 潘颖[1] 刘鹏鹏 吴爱芬 虞凯杰 ZHOU Yi;CAI Shibin;CHEN Shuzheng;FENG Yaqin;PAN Yin;LIU Pengpeng;WU Aifen;YU Kaijie(Department of Breast Surgery,Lishui Municipality Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院乳腺外科,323000

出　　处：《浙江医学》2020年第23期2533-2537,共5页Zhejiang Medical Journal

基　　金：丽水市科技计划项目(2017ZDXK10)。

摘　　要：目的探讨超声造影联合金属标记夹定位在乳腺癌新辅助化疗后前哨淋巴结活检中的应用价值。方法选取2016至2019年丽水市中心医院乳腺外科收治的经空芯针穿刺活检确诊为浸润性乳腺癌、针吸细胞学检查腋窝淋巴结转移的患者(临床分期T1~4N1~3M0)32例。所有患者均在接受新辅助化疗前先行超声造影确定前哨淋巴结,然后在超声引导下行针吸细胞学检查明确淋巴结转移后放置金属标记夹定位,术中应用亚甲蓝示踪前哨淋巴结后行前哨淋巴结活检并同时行腋窝淋巴结清扫术,比较前哨淋巴结活检与腋窝淋巴结清扫结果,统计标记的前哨淋巴结在前哨淋巴结标本中的比例、检出率、灵敏度、假阴性率及准确率,分析影响检出率及假阴性率的临床病理特征。结果32例患者全部完成新辅助化疗并行手术治疗;32例中28例标记淋巴结在前哨标本中(28/32),2例在清扫标本中,2例前哨及清扫标本中均未找到标记淋巴结;32例患者中2例前哨标本未检出淋巴结,余30例至少检出1枚前哨淋巴结,2例假阴性,检出率为93.7%(30/32),灵敏度为0.909(20/22),假阴性率为9.1%(2/22),准确率为93.3%(28/30)。前哨淋巴结检出率、假阴性率与标记的前哨淋巴结是否在前哨标本有关(P<0.05)。结论超声造影联合金属标记夹定位阳性前哨淋巴结应用于乳腺癌新辅助化疗后前哨淋巴结活检,有助于提高标记淋巴结位于前哨淋巴结标本中的比例及降低前哨淋巴结假阴性率。Objective To evaluate the application of contrast-enhanced ultrasonography with marker-clip in sentinel lymph node biopsy of breast cancer after neoadjuvant chemotherapy.Methods Thirty two patients with invasive breast cancer and axillary lymph node-positive(cT1-4N1-3M0)diagnosed by core needle biopsy were enrolled for a prospective cohort study in the department of breast surgery of Lishui Municipality Central Hospital from 2016 to 2019.All patients underwent contrast-enhanced ultrasonography to identification of sentinel lymph nodes,then ultrasound-guided fine-needle aspiration cytology was performed to confirm lymph node metastasis and marker-clip was placed in positive node before neoadjuvant chemotherapy.Sentinel lymph node biopsy was performed after neoadjuvant by methylene blue,followed by axillary lymph node dissection.The identification rate,sensitivity,false negative rate and accuracy rate of sentinel lymph node biopsy were analyzed.The clinicopathological features influencing the detection rate and false negative rate were analyzed.Results Two of the 34 patients withdrew from the study,the rest completed neoadjuvant chemotherapy and surgery.Among 32 patients the clipped-node was within SLN specimen in 28,within ALND specimen in 2 patients within,and the clipped-node was not found in rest 2 patients.At least one sentinel lymph node was detected in 30 patients with an identification rate of 93.7%(30/32).The sensitivity was 0.909(20/22),false negative rate was 9.1%(2/22),and the accuracy rate was 93.3%(28/30).The detection rate and false negative rate of sentinel lymph nodes were related to the inclusion of sentinel nodes in sentinel specimens(P<0.05).Conclusion The application of contrast-enhanced ultrasonography combined with placement of marker-clip in sentinel lymph node biopsy of breast cancer after neoadjuvant chemotherapy can improve the detection rate of sentinel lymph node in SLN specimen and reduce the false negative rate.

关 键 词：超声造影 金属标记夹 乳腺癌 前哨淋巴结活检 新辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]