临床早期乳腺癌前哨淋巴结活检替代腋清扫术的研究

目的　探讨前哨淋巴结活检术 (sentinellymphnodebiopsy ,SLNB)在乳腺癌治疗中的应用。 方法　使用蓝染料和 /或99mTc标记的硫胶体对 1999年 9月～ 2 0 0 2年 12月山东省肿瘤防治研究院连续收治的 42 3例临床查体腋窝淋巴结阴性乳腺癌患者行前哨淋巴结活检术 ,对 60例患者进行SLNB替代全腋窝淋巴结切除术 (axillarylymphnodedissection ,ALND)的前瞻性研究。结果　SLNB成功率为 98 6% (4 17/4 2 3 ) ,准确率为 93 0 % ,假阴性率为 16 5 %。单纯蓝染料法的分别为98 1% ,91 4%和 2 1 3 % ;联合使用蓝染料和99mTc标记的硫胶体组者分别为 10 0 % ,98 0 %和 4 1%。SLNB的方法对成功率和假阴性率有显著性影响。 60例患者进行了SLNB替代ALND的研究 ,其中 13例因术中发现前哨淋巴结转移而进行AL ND ,SLNB替代ALND者未发现明显术后并发症 ,47例仅行SLNB患者中位随访 8个月 ,未发现腋淋巴结复发者。结论　SLN能够准确预测腋窝淋巴结的转移状况 ,联合法的假阴性率明显低于单用染料法者。SLNB缩小了手术范围、减轻患者术后并发症 ,近期结果良好

The study of sentinel lymph node biopsy replacing axillary lymph node dissection in clinically early breast cancer

Objective: To study the value of sentinel lymph node biopsy (SLNB) in clinical node negative breast cancer. Methods: 423 patients treated with sentinel lymph nodes biopsy (SLNB) from September, 1999 to December 2002 in Shandong Cancer Hospital & Institute were studied by Blue Dye and/or 99m Tc?labeled sulfur colloid. From December, 2001, 60 patients, with tumor less than 3 cm , were treated with SLNB instead of axillary lymph node dissection (ALND). Results: SLNB was successfully identified in 417 of 423 (98 2%) patients. The accuracy rate of SLNB to predict axillary lymph node status was 93 1%, with 16 5% false negative rate. The success rate, accuracy rate and false negative rate by blue dye and combined method were 98 1%, 91 4%, 21 3%, and 100%, 98 0%, 4 1%, respectively. The false negative rate in combined group is significantly lower than blue dye group only. In the 47 patients with negative SLNB, SLNB was performed instead of ALND. During the next eight month, no axillary relapse was found in these patients. Conclusions: SLNB could accurately predict the axillary status in clinical node negative breast cancer patients. The extent of axillary dissection was decreased significantly in SLNB group only, and a better outcome was obtained presently.