乳腺癌淋巴结转移规律对术后放射治疗设野的影响

目的 探讨乳腺癌淋巴结转移规律和乳腺癌根治术后放射治疗的适应证及照射范围。方法 行选择性胸膜外式乳腺癌扩大根治术78例，分析其中资料完整的61例，探讨内乳淋巴结的转移情况。非选择性乳腺癌根治术 锁骨上淋巴结清扫术46例，术前检查锁骨上淋巴结均为阴性，将锁骨上淋巴结及腑窝淋巴结分别标记为S及L1、L2、L3送检。行乳腺癌根治术412例，标记出L1、L2、L3淋巴结分别送检，用以分析腋窝淋巴结跳跃式转移的规律。结果 内乳淋巴结总的转移率为24.6%，其中腋窝淋巴结转移者，内乳淋巴结转移率为36.7%，而腋窝淋巴结无转移者，内乳淋巴结转移率为12.9%，转移部位仅限于1、2、3肋间。锁骨上淋巴结跳跃式转移率为3.8%；腋窝淋巴结的跳跃式转移率为8.1%。结论 乳腺癌淋巴结转移有其内在规律，乳腺癌根治术后照射野可以依据其区域淋巴结的转移规律进行修改，照射内乳区淋巴结时可以不必常规包括4、5肋间。当腋窝淋巴结仅有L1、L2组转移而无L3组转移时，锁骨上淋巴结区也可以不予照射。

The pattern of lymphatic metastasis of breast cancer and its influence on the delineation of radiation fields

Objective To explore the pattern of lymphatic metastasis of breast cancer and indications for radiotherapy after radical mastectomy and to discuss the delineation of radiation fields. Methods From September 1980 to April 1999, 78 breast cancer patients received extended radical mastectomy in the Margottini model and 61 cases with complete data were analysed to investigate the intramammary lymphatic metastatic status. From March to December 1988, 46 patients with clinically negative axillary node received radical mastectomy plus supraclavicular lymph node dissection. The supraclavicular lymph nodes as axillary lymph nodes were labeled as S, L 1, L 2, L 3 and examined pathologically. From January 1996 to April 1999, 412 patients who had radical mastectomy underwent the pathological examination of level 1, level 2, and level 3 axillary lymph nodes. Results Total incidence of intramammary lymph node metastasis was 24.6%. It was 36.7% for those patients with positive axillary lymph node and 12.9% for those with negative axillary lymph node. The metastatic intramammary lymph nodes were located at the first, second and third intercostal spaces. Skipping metastasis in the supraclavicular lymph node was observed in 3.8% of patients and the skipping metastasis of axillary lymph nodes was 8.1%. Conclusions There is a readily available rule for the metastasis of regional lymph nodes in breast cancer patients. According to our data, we suggest that the radiation field for intramammary lymph node should exclude the fourth and fifth intercostal spaces. It is unnecessary to irradiate the supraclavicular lymph nodes when level 1 and level 2 axillary lymph nodes were negative.