结合前哨淋巴结冰冻检测阳性数免除早期乳腺癌腋窝清扫的可行性分析  

The Feasibility of Avoiding Axillary Lymph Node Dissection of Early Breast Cancer Combined with Positive Number of Sentinel Lymph Node via Frozen Section

作　　者：梁晨露 李鏐祎 竺美珍 扈杰杰 俞洋 LIANG Chen-lu;LI Liu-yi;ZHU Mei-zhen;HU Jie-jie;YU Yang(The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]中国科学院大学附属肿瘤医院(浙江省肿瘤医院),中国科学院基础医学与肿瘤研究所,浙江杭州310022

出　　处：《肿瘤学杂志》2021年第7期526-530,共5页Journal of Chinese Oncology

基　　金：浙江省自然科学基金(LY19H160005)。

摘　　要：[目的]探究在后Z0011时代,冰冻检测的前哨淋巴结(sentinel lymph node,SLN)阳性数目对于术中腋窝进一步治疗的指导意义。[方法]回顾性分析2013年至2019年在浙江省肿瘤医院诊治的浸润性乳腺癌患者,术中SLN行冰冻检测。结合常规病理结果评估冰冻检测的效能。以SLN阳性数≤2枚和>2枚作为分类,计算冰冻检测和常规病理检测SLN阳性数目的符合率。[结果]共有1841例患者纳入研究,假阴性率为25.6%。宏转移、微转移和孤立肿瘤细胞转移的假阴性率分别为14.3%,58.2%和79.3%。有227例冰冻病理记录了SLN转移数目,冰冻病理检测与常规病理检测的SLN阳性数符合率为95.6%(217/227)。结合冰冻结果,87.2%(198/227)SLN阴性且符合Z0011标准的患者可免除腋窝淋巴结清扫。[结论]冰冻检测是一项安全有效的SLNB方法。结合术中冰冻检测的SLN阳性数目,符合Z0011标准的患者可以避免腋窝淋巴结清扫。[Objective]To explore the guiding significance of the positive number of SLN via frozen section for the further treatment of axillary in the post-Z0011 era.[Methods]This study retrospectively analyzed patients with primary breast cancer who underwent SLN biopsy in Zhejiang Cancer Hospital from2013 to 2019.Combined with the final paraffin section results,the effectiveness of frozen section was calculated.According to the classification of SLN positive number≤2 and>2,the coincidence rate of SLN positive number between frozen section and final paraffin section was calculated.[Results]A total of 1841 patients were included in the study.The overall false negative rate(FNR)was 25.6%.The FNR of macrometastasis,micrometastasis and isolated tumor cell metastasis were 14.3%,58.2%and 79.3%,respectively.227 cases recorded the number of SLN metastases detected by frozen section.The coincidence rate of the number of positive SLN between frozen section and final paraffin section was 95.6%(217 of 227).Combined with the frozen section,87.2%(198/227)of SLN positive patients who met the Z0011 standard could avoid axillary lymph node dissection(ALND).[Conclusion]Frozen section is a safe and effective SLN biopsy method.Combined with the positive number of SLN detected by intraoperative frozen section,patients who meet the Z0011 standard can avoid ALND.

关 键 词：乳腺癌 前哨淋巴结 冰冻检测 

分 类 号：R737.9[医药卫生—肿瘤]