乳腺癌前哨淋巴结活检技术

目的 探讨不同方法检测乳腺癌前哨淋巴结（sentinel lymph node,SLN)的可行性及其临床意义。方法 71例经细针穿刺或术中冰冻切片诊断为乳腺癌而临床无腋窝淋巴结肿大的女性患者,随机分为4组,其中亚甲蓝淋巴示踪24例,活性染料异硫蓝示踪29例,核素^99m锝－硫胶体示踪8例,染料与核素联合示踪10例,确认并切除前哨淋巴结,将其单独送病理,随后行乳腺癌手术,包括传统的腋窝淋巴结清扫术。结果 71例患者中有60例成功确定前哨淋巴结,检出率84．5％,其中亚甲蓝组75．0％（18／24）,异硫蓝组86．2％（25／29）,核素组检出7例,联合组全部检出;该技术总的敏感性83．3％,4组分别为70．0％、90．0％、100％、100％;假阴性率各组分别为30．0％、10．0％、0、0;总的准确率93．3％,各组分别为83％、96．0％、100％、100％。各组寻找前哨淋巴结平均花费时间分别为29、22、7、6min。结论 前哨淋巴结活检技术在临床是可行的。绝大多数前哨淋巴结可以比较准确地反映其余腋窝淋巴结的组织学特点。活性染料与核素联合示踪既直观又准确,是最佳的选择方法。

Detection of sentinel lymph node in patients with breast cancer

Objective To evaluate the technique and significance of the sentinel lymph node (SLN) biopsy using different methods in patients with breast cancer. Methods Seventy one female patients with node negative breast cancer diagnosed by fine needle biopsy or frozen section underwent lymphatic mapping. They were divided into 4 groups: methylene blue, isosulfan blue, 99m technetium labelled sulfur colloid, combined vital blue dye and radiocolloid. The number of each group was 24, 29, 8 and 10 respectively. The SLN was identified and removed, followed by a definitive cancer operation, including a complete axillary node dissection. Pathological examination of the SLN was made with HE and immunohistochemical staining. Pathologic characteristics of SLN and other axillary nodes were analyzed. Results Among the 71 patients, 60 were (84 5%) confirmed by SLN biopsy. The positive rates were 75 0%(18/24) for methylene blue group and 86 2%(25/29) for isosulfan blue group, respectively. Seven positive cases were detected by 99m technetium labelled sulfur colloid and all the positive cases by combined vital blue dye and radiocolloid. The total sensitivity was 83 3% and the sensitivity for each group was 70 0%, 90 0%, 100% and 100%, respectively The total false negative rate was 16 7% and the false negative rate for each group was 30 0%, 10 0%, 0 and 0, respectively. The total accuracy rate was 93 3% and the accuracy rate for each group was 83 3%, 96 0%, 100% and 100%, respectively. The time of finding the SLN was 29, 22, 7, 6 min respectively. Conclusions SLN biopsy is technically possible in patients with breast cancer. Most of SLNs can probably reflect the histological characteristics of the axillary lymph nodes. Combination of vital blue dye and isotope makes mapping exact and satisfactory and it may be the best choice among the four methods.