美蓝染色联合术中超声探查在乳腺癌前哨淋巴结活检中的应用

目的：探讨美蓝染色联合术中超声探查在乳腺癌手术中提高前哨淋巴结（SLN）阳性检出率的临床实用性和优势。方法：选取2020年1月至2020年12月在温州医科大学附属第二医院手术的145例临床腋淋巴结阴性的早期乳腺癌患者，通过美蓝染色联合术中超声探查进行前哨淋巴结活检（SLNB），检出的淋巴结均进行术中冰冻及术后石蜡病理检查，分别计算蓝染SLN及超声探查可疑SLN，以及分别所含的转移性淋巴结数目。结果：145例患者均成功蓝染并顺利行SLNB，通过美蓝染色法转移阳性SLN检出率为21.7%（114/526），联合术中超声探查转移阳性SLN检出率为26.2%（155/591），差异有统计学意义（P＜0.05）；通过美蓝染色法宏转移SLN检出率为7.0%（8/114），而联合术中超声探查宏转移SLN检出率为18.7%（29/155），差异有统计学意义（P＜0.05）。结论：美蓝染色在乳腺癌SLNB中存在一定的漏诊率，结合术中超声探查可明显提高SLN阳性检出率。

The study of methylene blue combined with intraoperative ultrasound exploration in sentinel lymph node biopsy of breast cancer

Objective: To investigate the clinical practicability and advantages of methylene blue staining combined with intraoperative ultrasound exploration in improving the removal rate and positive detection rate of sentinel lymph node (SLN) during breast cancer surgery. Methods: From Jan. 2020 to Dec. 2020, 145 consecutive cases with clinical axillary lymph node-negative early breast cancer were enrolled. All patients underwent sentinel lymph node biopsy (SLNB) through methylene blue staining combined with intraoperative ultrasound detection. Intraoperative frozen and postoperative paraffin pathological examinations were performed to SLN, with respectively calculation of the blue-stained SLN and the suspicious SLN detected by ultrasound as well as the number of metastatic lymph nodes contained in each. Results: All 145 patients were blue stained and successfully underwent SLNB. The detection rate of positive SLN by methylene blue staining was 21.7% (114/526), and the detection rate of positive SLN combined with intraoperative ultrasound detection was 26.2% (155/591), with significant difference (P<0.05); the detection rate of macrometastasis SLN by methylene blue staining was 7.0% (8/114), and the detection rate of macrometastasis SLN combined with intraoperative ultrasound exploration was 18.7% (29/155), with significant difference (P<0.05). Conclusion: The use of methylene blue staining has a certain rate of missed diagnosis in breast cancer SLNB. However, combined with intraoperative ultrasound exploration, it is of clinical significance by remarkably increasing the SLN resection rate and positive detection rate.