前哨淋巴结快速活检在乳腺癌根治术中的意义

目的：探讨乳腺癌前哨淋巴结活检(sentinel lymph node biopsy，SLNB)的可行性和准确性，及其在乳腺癌手术中的临床应用价值。方法：对32例乳腺癌病人行SLNB，术中在肿瘤周边选二点注射1％美蓝5ml，根据肿块距腋窝的距离，5～10min后沿腋窝下皱折线切开，循蓝染淋巴管寻找前哨淋巴结(sentinel lymp hnode，SLN)。其中27例切除SLN后行腋窝淋巴结解剖(axillry lymph node dissection，ALND)，两标本同时送病理检查，了解其符合率，并评价SLNB的可行性。结果:全组均进行了SLNB识别定位，1例未取到SLN，检出率为96．9％；另一例SLN病理呈假阴性。按目前国外SLNB的评价标准，本组SLNB的敏感度为88．2％，准确性为96．9％，假阳性率为0，假阴性率为5．9％。结论:乳腺癌SLNB目前仍处于研究阶段，随着研究的深入与扩大，将成为早期乳腺癌的诊疗常规，阴性可避免ALND的痛苦。

Significance of Sentinel Lymph Node Biopsy in Radical Mastectomy for Breast Cancer

Objective To study the feasibility and accuracy of sentinel lymph node biopsy(SLNB) for breast cancer and its clinical application value in breast cancer operation. Methods In this operation, 5 ml 1% methylene blue was injected into two sites around the tumor. After 5 to 10 minutes, according to the distance between tumor and axilla, the skin was cut along the crease under axilla and sentinel lymph node(SLN) was found along the blue stained lymphatic vessel. Among the 32 patients registered, 27 received axillary lymph node dissection(ALND) after SLN resection, and two specimens from each case were delivered to pathologic exam at the same time in order to study the coincidence rate and evaluate the feasibility of SLNB. Results 32 patients received SLNB recognization and localization. One case did not get SLN in operation.Detection rate of SLN was 96.9%. One patient's pathologic result of SLN showed false negative. According to SLNB evaluation criterion abroad, in this trial, sensitivity of SLNB was 88.2%, accuracy 96.9%, false positive rate 0 and false negative 5.9%. Conclusions At present, SLNB for breast cancer is still at the research phase. With further and deeper study, SLNB may replace routine ALND.