不同示踪方式在新辅助化疗后前哨淋巴结活检中效果  

EFFECT OF DIFFERENT TRACING METHODS IN SENTINEL LYMPH NODE BIOPSY AFTER NEOADJUVANT CHEMOTHERAPY

作　　者：郑燕[1] 马腾[1] 郑帅 吕志栋[1] 王海波[1] ZHENG Yan;MA Teng;ZHENG Shuai;Lü Zhidong;WANG Haibo(Center of Diagnosis and Treatment of Breast Disease,The Affiliated Hospital of Qingdao University,Qingdao 266100,China)

机构地区：[1]青岛大学附属医院乳腺病诊疗中心,山东青岛266100

出　　处：《青岛大学学报（医学版）》2021年第3期373-376,共4页Journal of Qingdao University(Medical Sciences)

基　　金：山东省自然科学基金博士基金项目(ZR2017-BH061)。

摘　　要：目的比较亚甲蓝、亚甲蓝联合核素与亚甲蓝联合吲哚氰绿(ICG)在新辅助化疗(NAC)后前哨淋巴结活检(SLNB)中的效果,评估3种示踪方式在乳癌NAC后SLNB中的应用价值,探讨乳癌NAC后进行SLNB的可行性。方法回顾性分析2018年1月—2019年5月在青岛大学附属医院乳腺病诊疗中心行NAC后SLNB的142例乳癌病人的临床资料,SLNB分别在亚甲蓝、亚甲蓝联合核素与亚甲蓝联合ICG显影下进行。比较3种示踪方式SLNB的检出情况、假阴性率、灵敏度、准确率。结果 142例病人中,成功检出前哨淋巴结(SLN)139例,共检出467枚SLN,SLN的检出率达96.36%(139/142)。亚甲蓝组平均检出SLN(2.47±1.03)个,检出率为96.36%(53/55),假阴性率为18.18%(6/33),准确率为88.68%(47/53),灵敏度为81.82%(27/33);亚甲蓝+ICG组平均检出SLN(3.67±1.51)个,检出率为97.78%(44/45),假阴性率为17.39%(4/23),准确率为90.91%(40/44),灵敏度为82.61%(19/23);亚甲蓝+核素组病人平均检出SLN(3.98±1.53)个,检出率为100.00%(42/42),假阴性率为12.00%(3/25),准确率为92.86%(39/42),灵敏度为88.00%(22/25)。3组间比较,平均检出SLN个数差异有显著性(F=12.136,P<0.05),而检出率、灵敏度、准确率、假阴性率等差异无统计学意义(P>0.05)。初始腋窝淋巴结阴性乳癌病人的假阴性率为7.14%,初始腋窝淋巴结阳性、SLN>2枚者的假阴性率为9.68%,初始腋窝淋巴结阳性、SLN≤2枚者的假阴性率为36.36%。结论 3种示踪方式应用于乳癌NAC后SLNB均有较高的检出率,但双示踪在SLN的检出数量上明显优于单示踪。初始腋窝淋巴结阴性及初始腋窝淋巴结阳性且SLN>2枚者的假阴性率可以被接受,而初始腋窝淋巴结阳性且SLN≤2枚者的假阴性率过高,需进一步行腋窝清扫术。Objective To investigate the effect and application value of methylene blue alone,methylene blue combined with radionuclide,and methylene blue combined with indocyanine green(ICG)in sentinel lymph node biopsy(SLNB)after neoadjuvant chemotherapy(NAC)for breast cancer,as well as the feasibility of SLNB after NAC for breast cancer.Methods A retrospective analysis was performed for the clinical data of 142 patients with breast cancer who underwent SLNB after NAC in Center for Diagnosis and Treatment of Breast Diseases,The Affiliated Hospital of Qingdao University,from January 2018 to May 2019,and SLNB was performed using methylene blue alone,methylene blue combined with radionuclide,or methylene blue combined with ICG.The three tracing methods were compared in terms of detection rate,false negative rate,sensitivity,and accuracy.Results Among the 142 patients,139 were found to have sentinel lymph nodes(SLNs),and a total of 467 SLNs were detected,with a detection rate of 96.36%(139/142).In the methylene blue group,2.47±1.03 SLNs were detected,with a detection rate of 96.36%(53/55),a false negative rate of 18.18%(6/33),an accuracy of 88.68%(47/53),and a sensitivity of 81.82%(27/33);in the methylene blue+ICG group,3.67±1.51 SLNs were detected,with a detection rate of 97.78%(44/45),a false negative rate of 17.39%(4/23),an accuracy of 90.91%(40/44),and a sensitivity of 82.61%(19/23);in the methylene blue+radionuclide group,3.98±1.53 SLNs were detected,with a detection rate of 100.00%(42/42),a false negative rate of 12.00%(3/25),an accuracy of 92.86%(39/42),and a sensitivity of 88.00%(22/25).There was a significant difference in the average number of SLNs detected between the three groups(F=12.136,P<0.05),while there were no significant differences in detection rate,sensitivity,accuracy,and false negative rate(P>0.05).The false negative rate of SLNB was 7.14%in the breast cancer patients with negative axillary lymph node,9.68%in the breast cancer patients with positive axillary lymph node and SLN>2,and 36.36%in the breas

关 键 词：乳房肿瘤 化学疗法 辅助 前哨淋巴结活组织检查 亚甲蓝 吲哚花青绿 放射性示踪剂 

分 类 号：R737.9[医药卫生—肿瘤] R446.8[医药卫生—临床医学]