前哨区域淋巴结活检术在早期乳腺癌中的应用分析  

Application analysis of sentinel area lymph node biopsy in early breast cancer

作　　者：于昌盛[1] 方芳[1] 王亚兵[1] 李强[1] 陈剑平[1] 殷照才[1] 李琴 董兵斌 杨二龙 Yu Changsheng;Fang Fang;Wang Yabing;Li Qiang;Chen Jianping;Yin Zhaocai;Li Qin;Dong Bingbin;Yang Erlong(Department of Thyroid and Breast Surgery,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院甲乳外科,芜湖241001

出　　处：《国际外科学杂志》2021年第12期833-838,F0004,共7页International Journal of Surgery

基　　金：2020年安徽省高等学校人文社会科学研究项目(SK2020A0371)。

摘　　要：目的探讨早期乳腺癌患者在行前哨区域淋巴结(SALN)活检术后,SALN数目与非前哨区域淋巴结(NSALN)转移的相关性。方法回顾性选取2016年1月—2021年7月于皖南医学院弋矶山医院甲乳外科行SALN活检的400例早期乳腺癌女性患者,对其临床病例资料进行归纳和分析。计数资料组间比较采用χ^(2)检验或Fisher确切概率法。对研究指标先进行单因素分析,然后筛选出差异具有统计学意义的指标再进行多因素Logistic回归分析,并绘制受试者工作特征曲线,结合曲线下面积,建立预测模型。结果400例早期乳腺癌患者均行SALN活检术,320例全乳切除共检出1504枚淋巴结,平均4.7枚,47例宏转移,术后宏转移2例,假阴性率为4.3%。SALN阳性67例,阳性率为16.75%(67/400)。单因素分析结果显示,脉管癌栓、SALN阳性数目与NSALN转移密切相关(χ^(2)=8.775、16.53,P=0.003)。多因素Logistic回归分析结果显示,脉管癌栓、SLN阳性数≥3枚是NSLN转移的独立预测风险因子(OR=16.149,95%CI:3.016~86.473,P<0.001;OR=31.76,95%CI:5.242~192.43,P<0.001)。SALN阳性与NSALN转移密切相关,但是随着检出SALN数量增多(大于6枚)并且在SALN只有1~2枚阳性的情况下,NSALN发生转移的概率明显降低(P<0.05)。结论SALN阳性数目、脉管癌栓与NSALN转移关系密切。SALN阳性数目≥3枚是NSALN转移最主要的独立预测因素。采用SALN活检术可增加前哨淋巴结检出数,降低NSALN复发风险,如1~2枚阳性前哨淋巴结时,并且前哨淋巴结的检出数>6枚的时候,可酌情免除腋窝淋巴结清扫。Objective To explore the correlation between the number of sentinel regional lymph node(SALN)and non-sentinel regional lymph node(NSALN)metastasis in patients with early breast cancer after sentinel regional lymph node(SALN)biopsy.Methods Retrospectively selected 400 female patients with early breast cancer who underwent SALN biopsy at the Department of Thyroid and Breast Surgery,Yijishan Hospital of Wannan Medical College from January 2016 to July 2021,and summarized and analyzed their clinical case data.The Chi-square test or Fisher exact probability method was used to compare the count data between groups.Perform single-factor analysis on the research indicators,then screen out indicators with statistically significant differences,then perform multi-factor Logistic regression analysis,draw a receiver operating characteristic curve,and combine the area under the curve to establish a predictive model.Results SALN biopsy was performed in 400 patients with early breast cancer.A total of 1504 lymph nodes were detected in 320 cases of total mastectomy,with an average of 4.7,47 cases of macrometastasis,and 2 cases of postoperative macrometastasis.The false negative rate was 4.3%.Among 400 cases,67 cases were positive for SALN,and the positive rate was 16.75%(67/400).The results of univariate analysis showed that the number of tumor thrombus in the vessel,the number of positive SALN and the metastasis of NSALN were closely related(χ^(2)=8.775,16.53,P=0.003).The results of multivariate Logistic regression analysis showed that the number of tumor thrombi and SLN-positive≥3 in the vessel were independent predictive risk factors for NSLN metastasis(OR=16.149,95%CI:3.016-86.473,P<0.001;OR=31.76,95%CI:5.242-192.43,P<0.001).SALN positive was closely related to NSALN metastasis,but as the number of SALN detected increases(more than 6)and when only 1 to 2 SALN was positive,the probability of NSALN metastasis was significantly reduced(P<0.05).Conclusions The positive number of SALN and intravascular tumor thrombolus were clo

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 示踪剂 亚甲蓝 非前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]