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1.
乳腺癌前哨淋巴结活检的临床意义   总被引:2,自引:2,他引:0  
目的:研究乳腺癌前哨淋巴结(SLN)活检方法,探讨SLN对腋窝淋巴结状态的预测价值及其临床意义。方法:95例早期乳腺癌患者,采用亚甲蓝为示踪剂行SLN定位活检,继行腋窝淋巴结清扫。结果:SLN检出成功率为97.89%(93/95);准确性为97.85%(91/93);灵敏性为91.67%(22/24);假阴性率为8.33%(2/24);特异性为100%(71/71)。结论:蓝染料乳晕区皮下注射SLN定位活检成功率高,能较准确地预测腋窝淋巴结状态。  相似文献
2.
乳腺癌前哨淋巴结术中分子诊断的研究   总被引:1,自引:0,他引:1  
目的 评估乳腺癌前哨淋巴结(SLN)术中分子诊断--GeneSearchTM BLN Assay (BLNa)的诊断价值.方法 2009年2至6月,全国6家乳腺中心的479例乳腺癌患者入组本研究.SLN均垂直于长轴切割为1.5~3 mm组织块,术中奇数组织块行BLNa检测,术后偶数组织块行逐层切片病理检测(采用间隔150 μm的逐层切片HE染色,每个组织块取6张切片).214例患者的偶数组织块行术中快速冰冻病理(FS)检测,156例患者的所有组织块术中行印片细胞学(TIC)检测.结果 BLNa操作呈现良好的学习曲线,各中心的敏感性和特异性差异均无统计学意义(分别P=0.672;P=0.628),中位操作时间约35 min.以病例数为统计对象分析,BLNa的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为91.4%、87.5%、92.9%、81.8%、95.3%,其敏感性与FS相似(84.5%,P=0.576),显著优于TIC(75.0%,P=0.049).以淋巴结数为统计对象分析,BLNa的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为93.0%、85.6%、94.6%、76.6%、96.9%,其敏感性与FS相似(84.9%,P=0.885),显著优于TIC(70.0%,P=0.007).对于伴有宏转移的SLN,BLNa的敏感性为93.6%,与FS相似(95.6%,P=0.558),显著优于TIC(80.9%,P=0.011);对于伴有微转移的SLN,BLNa的敏感性为57.5%,有优于FS和TIC的趋势(分别44.4%,P=0.356;30.8%,P=0.094).结论 GeneSearchTM BLN Assay检测快速,易于操作,具有较高的准确性和可重复性,其敏感性优于FS和TIC,可作为SLN术中诊断的首选.
Abstract:
Objective To evaluate the clinical value of GeneSearchTM BLN Assay as an intraoperative diagnostic method of sentinel lymph node (SLN) for breast cancer patients. Methods A total of 479 consecutive patients from six centers were involved in this prospective study. The SLNs were identified,dissected and then sectioned along the short axis into multiple blocks. The odd blocks were tested intraoperatively by the above-mentioned assay and the even blocks assessed post-operatively by histopathologic examination. The 4 -6 μm thick stepwise sectioning permanent HE slides were prepared every 150 μm and one block yielded 6 slides. In addition, the even blocks of 136 patients were prepared for frozen section (F S) and all blocks of 156 patients evaluated intra-operatively by touch imprint cytology (TIC). Results In the node basis analysis, its accuracy, sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) were 93.0%, 85.6%, 94. 6%, 76.6% and 96.9% respectively. Its sensitivity was similar to that of FS ( 84. 9%, P = 0. 885 ) and significantly higher than that of TIC (70. 0%, P = 0. 007 ).When assessing nodes with macro-metastases, its sensitivity was similar to that of FS (93.6% vs 95.6%,P =0. 558) and significantly higher than that of TIC (93.6% vs 80.9%, P = 0. 011 ). When assessing nodes with micro-metastases, it had a higher sensitivity than that of FS (57.5% vs 44.4%, P =0. 356) and TIC (57. 5% vs 30. 8%, P =0. 094). In the patient basis analysis, the accuracy, sensitivity, specificity,PPV and NPV were 91.4%, 87. 5%, 92. 9%, 81.8% and 95. 3% respectively. Its sensitivity was similar to that of FS (84. 5%, P =0. 576) and significantly higher than that of TIC (75.0%, P =0. 049). After adjustment, it had the accuracy, sensitivity, specificity, PPV and NPV of 91.7%, 83. 5%, 95.2%,88. 3% and 93.0% respectively. Its sensitivity was higher than that of FS (72. 1%, P = 0.054) and significantly higher than that of TIC ( 66. 7%, P= 0. 011 ). The two had no significant difference in the sensitivity and specificity. After a learning curve of around 10 cases, it could be performed in a median time of around 35 min. The threshold cycle time values of MG and CK-19 were 36 and 31 respectively. The type of metastases could be estimated approximately according to the cycle time values. The cycle time values of MG under 33 indicated SLN macro-metastases and those of 33 - 36 denoted micro-metastases. The values of CK-19 under 29 indicated SLN macro-metastases and those of 29 -31 denoted micro-metastases. Conclusion As an accurate and rapid intra-operative assay for breast sentinel lymph nodes, the GeneSearchTM BLN Assay may replace FS and TIC in general medical practice.  相似文献
3.
前哨淋巴结活检在胃癌外科中临床意义的研究   总被引:1,自引:0,他引:1  
目的 探讨前哨淋巴结活检在胃癌外科中的临床应用及其意义.方法 术中在肿瘤四周的胃壁上注射亚甲蓝,第一个蓝染淋巴结,即前哨淋巴结(SLN),摘取所有前哨淋巴结并进行HE染色及细胞角蛋白免疫组化(IHC-CK)染色检查.结果 96例患者中92例成功检出前哨淋巴结,检出率为95.8%.在T1,T2期胃癌中,由SLN预测胃周淋巴结转移的准确率为93.8%(15/16),敏感性为87.5%(7/8),在T3期胃癌中,由SLN预测胃周淋巴结转移的准确率为67.1%(51/76),敏感性为52.8%(28/53).结论 术中使用亚甲蓝染色定位胃癌前哨淋巴结是安全可行的,前哨淋巴结的检出对胃癌淋巴结清扫范围的选择有一定意义.  相似文献
4.
亚甲蓝染料示踪法在乳腺癌前哨淋巴结活检中的应用   总被引:1,自引:0,他引:1  
目的 比较分析单用亚甲蓝染料示踪法在乳腺癌前哨淋巴结活检(SLNB)中的价值.方法 用腋窝淋巴结清扫术(ALND)或放射性同位素示踪法的结果对照分析弧甲蓝染料法在SLNB中的成功率、阴性预测值以及影响因素.结果 对早期乳腺癌患者,单用亚甲蓝染料法行SLNB中的成功率可达98.2%,临床淋巴结阴性患者中,阴性预测值可达100%.全组共免除ALND102例,其中单用亚甲蓝染料示踪法12例,中位随访时间28个月,未见腋窝复发病例.结论 亚甲蓝染料示踪法行SLNB 可安全用于临床分期为T1N0M0的早期乳腺癌患者.  相似文献
5.
乳腺癌前哨淋巴结活检的临床意义   总被引:1,自引:1,他引:0  
目的:探讨乳腺癌患者前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的可行性与临床意义。方法:23例乳腺癌患者术中癌周注射1%亚甲蓝溶液4ml,15min后行SLNB并独立送病理检查。结果:前哨淋巴结(sentinel lymph node,SLN)检出22例,检出成功率为95.7%,敏感6/7,假阴性率为4.76%(1/21)。结论:乳腺癌SLNB是一种简便、安全的检测技术,可用于了解腋窝淋巴结的状况。  相似文献
6.
The presence or absence of metastases in the axillary lymph nodes has remained the most powerful prognostic factor in breast carcinoma. Axillary lymph node dissection (ALND) is the standard procedure for obtaining this information. However, postoperative complications are common. Sentinel lymph node (SLN) biopsy has been proposed as a potential alternative to ALND for staging breast carcinoma. This technique has been shown to be sensitive and specific for predicting the status of the axillary lymph nodes. Furthermore, it has the potential advantage of decreasing the morbidity associated with ALND.  相似文献
7.
目的 探讨乳腺癌前哨淋巴结活检(SLNB)中吲哚菁绿(ICG)联合纳米炭悬浊液的应用价值.方法 将110例腋窝淋巴结阴性的早期乳腺癌患者,随机分成两组,分别采用注射用ICG联合纳米炭悬浊液(联合组,57例)和单用纳米炭悬浊液(纳米炭组,53例)为示踪剂行SLNB.SLNB后随即行腋窝淋巴结清扫.结果 联合组中55例可见荧光所示淋巴管道,荧光显像率96.49%(55/57),前哨淋巴结检出率98.25%(56/57),准确率96.43%(54/56),假阴性率6.67%(2/30),灵敏度93.33%(28/30);纳米炭组前哨淋巴结检出率94.34%(50/53),准确率96.00%(48/50),假阴性率8.33%(2/24),灵敏度91.67%(22/24).联合组共检出前哨淋巴结309枚,纳米炭组共检出前哨淋巴结218枚,两组前哨淋巴结平均检出枚数比较差异有统计学意义(P<0.05);而两组检出率、准确率、假阴性率和灵敏度这4个评价指标比较,差异均无统计学意义.结论 ICG与纳米炭悬浊液联合应用相比单用纳米炭悬浊液可提高前哨淋巴结检出数量,减少漏诊概率.  相似文献
8.
目的 评价乳腺癌患者在新辅助化疗(NCT)后行前哨淋巴结活检术(SLNB)可行性.方法 以“乳腺癌”、“新辅助化疗”及“前哨淋巴结活检”为自由词和主题词于中国生物医学文摘数据库(CBM)和PubMed、Medline及Embase数据库进行文献检索.按照严格的纳入、排除标准对所获得文献进行筛选.根据NCT前腋窝淋巴结状况分为腋窝淋巴结阴性组和腋窝淋巴结阳性组.对纳入文献记录提取必要数据后,使用STATA软件将各项研究结果合并后计算前哨淋巴结检出率及假阴性率.结果 共纳入41项原创性研究,共计5 848例患者.腋窝淋巴结阴性组患者2 050例,其中1 891例成功检出前哨淋巴结,检出率为0.94(95%CI 0.92~0.96),假阴性率为0.07(95%CI 0.04~0.10).腋窝淋巴结阳性组患者3 798例,3 059例成功检出前哨淋巴结,检出率为0.87(95%CI 0.84~0.90),假阴性率为0.13(95 %CI 0.11~0.16).结论 NCT前腋窝淋巴结阴性的乳腺癌患者可在NCT后行SLNB,NCT前腋窝淋巴结阳性患者则不建议NCT后行SINB.  相似文献
9.
目的:观察全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术(SLNB)治疗早中期乳腺癌的近期疗效和安全性,探讨手术技巧。方法:选取行2~4周期 TEC 方案新辅助化疗方案的早中期乳腺癌患者63例为研究对象,实施腔镜乳房皮下腺体切除术联合腔镜 SLNB,并对前哨淋巴结转移病例进一步行腔镜腋窝淋巴结清扫。记录术中前哨淋巴结活检结果、手术效果、术后并发症和复发、转移情况。结果:63例患者前哨淋巴结检出率100%(63/63),获取前哨淋巴结1~8枚,平均(3.5±0.7)枚,其中32例 SLNB 阳性者行腔镜腋窝淋巴结清扫术。术后并发症主要为乳头部分坏死4例、3例皮下气肿。术后随访平均(7.6±2.1)个月,无局部复发和远处转移。结论:全腔镜乳房皮下腺体切除术联合 SLNB 治疗早中期乳腺癌安全可行,良好的操作空间、充分溶脂、保护乳头乳晕处皮肤和皮下血运是手术成功的关键。  相似文献
10.
目的:探讨数字三维技术联合纳米碳辅助导航在乳腺癌腔镜前哨淋巴结活检手术的应用价值。方法入组2014年9月~2015年9月期间我科的39名Ⅰ、Ⅱ期女性乳腺癌患者,术前行CT淋巴造影,采集其数据并进行分割及三维重建,准确定位前哨淋巴结并进行腔镜前哨淋巴结活检及腋窝淋巴结清扫的可视化预演及临床手术,评价在数字三维技术指导下腔镜前哨淋巴结活检的准确性及应用价值。结果39例患者腋窝三维模型符合患者实际解剖,清晰显示前哨淋巴结、腋窝淋巴结与腋静脉、胸大肌、胸小肌、背阔肌等的三维关系。数字三维技术联合纳米碳辅助导航腔镜前哨淋巴结活检的检出率为100%,总符合率为87.18%(34/39),灵敏度为91.67%(11/12),假阴性率为8.33%(1/12)。术后随访半年,39例患者均未发现患侧腋窝皮下积液、感染、疼痛、水肿等并发症。结论数字三维技术联合纳米碳辅助导航腔镜前哨淋巴结活检术具有较高的检出率、灵敏度和较低的假阴性率,可作为前哨淋巴结活检的一种新方法。  相似文献
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