淋巴显像及术中γ探测定位活检乳腺癌前哨淋巴结

目的：探讨淋巴显像及术中γ探测定位活组织检查乳腺癌前硝淋巴结的临床价值。方法：术前在乳腺肿瘤表面正中皮内注射37－74MBq ^99Tcm-大分子右旋糖酐（Dx)，用淋巴显像和术中γ探测定位乳腺癌 前硝淋巴结，术中切除前 淋巴结，而后行腑窝淋巴结清扫术，两标本连同切除的乳腺肿物同时送病理检查，分析和前哨淋巴结转移与腋窝淋巴结的关系。结果：31例均行淋巴显像和术中γ探测定位乳腺癌前哨淋巴结患者中，检出率为100％，有3例前哨淋巴结病理检查呈假阴性，假阴性率为25％，结论：术中γ探测是乳腺癌前哨淋巴结定位最可靠的手段。以乳腺 癌前哨淋巴结活组织检查取代常规腑窝淋巴结清扫术尚需进一步研究。

Lymphoscintigraphy and intraoperative gamma probe guided biopsy of the sentinel lymph node in breast cancer

Objective To evaluate the role of lymphoscintigraphy and intraoperative gamma probe in sentinel lymph node identification and biopsy for breast cancer. Methods 99 Tc m labeled dextran (Dx) was injected intradermically at the skin surface center of breast tumor before mastectomy. The sentinel lymph nodes identified by lymphoscintigrphy and intraoperative gamma probe were dissected out from the axillary tissue. All sentinel and non-sentinel lymph nodes were sent to a pathologist for histological examination. The specimens were examined with hematoxylin and eosin (H and E) staining. Results In 31 cases studied, sentinel lymph nodes were all identified by lymphoscintigraphy and intraoperative gamma probe, with a detection rate of 100%. Metastases were detected in sentinel lymph nodes in 10 patients, however, 12 cases showed positive axillary lymph nodes but for 3 cases, sentinel lymph nodes were negative. The sensitivity of the sentinel lymph node biopsy in this study was 83.33%, the accuracy was 87.09%, the false positive rate was 0, and the false negative rate was 25%. Conclusions Intraoperative gamma probe detection is the best approach to identify sentinel lymph nodes in breast cancer. The attemptations that substitution of sentinel lymph node biopsy for routine axillary lymph node dissection in breast cancer deserves further study.