核素染料联合法在早期乳腺癌前哨淋巴结活检手术中的临床应用

目的探讨99Tcm-硫胶体和亚甲蓝蓝染料联合进行前哨淋巴结活检(sentinel lymph node biopsy,SLNB)在早期乳腺癌中的临床应用价值。方法本组201例患者均采用亚甲蓝蓝染料、99Tcm-硫胶体及两者联合应用进行SLNB,并记录相关临床病理数据,进行统计分析。结果 201例患者中成功检出前哨淋巴结(sentinellymph node,SLN)200例,其中染料法、核素法及联合法的SLN检出率分别为85.4%(170/199)、99.5%(200/201)和99.5%(198/199),染料法的SLN检出率较低(P<0.001);准确率分别为95.3%(162/170)、94.5%(189/200)和98.0%(194/198),差异无统计学意义(P=0.185);假阴性率分别为11.3%(8/71)、13.9%(11/79)和5.1%(4/79),差异无统计学意义(P=0.165)。联合法比染料法或核素法能检出更多的SLN(P<0.001)。相对于联合法,染料法和核素法分别有12例和7例SLN癌转移的患者漏检,漏诊率分别为16.0%(12/75)和9.3%(7/75)。结论联合法的SLN检出率较高,能检出更多的SLN,临床实践中应尽量采用联合法进行SLNB。

Clinical Application of Combination of Radiolabeled Colloid and Blue Dye in Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer

Objective To explore the clinical application of combination of radiolabeled colloid(99Tcm-sulphur colloid)and blue dye in sentinel lymph node biopsy(SLNB)for early-stage breast cancer.Methods SLNB was performed with the guidance of blue dye,radiolabeled colloid,and the combination method in all patients enrolled,and clinical and pathological data were recorded respectively for analysis.Results Two hundred and one patients were enrolled in this study and the SLN were successfully detected in 200 cases.The identification rate of radiolabeled colloid method and combination method was 99.5%(200/201)and 99.5%(198/199)respectively,which significantly higher than blue dye method(85.4%,P < 0.001).There were no differences of accuracy rate〔95.3%(162/170)vs.94.5%(189/200)vs.98.0%(194/198),P=0.185〕and false negative rate〔11.3%(8/71)vs.13.9%(11/79)vs.5.1%(4/79),P=0.165)between blue dye method,radiolabeled colloid method,and combination method.The combination method could detect more SLN than radiolabeled colloid method or blue dye method only(P < 0.001).Compared to combination method,there were 12 and 7 patients miss diagnosed in blue dye method and radiolabeled colloid method,and the miss diagnosed rate was 16.0%(12/75)and 9.3%(7/75),respectively.Conclusions Compared to radiolabeled colloid and blue dye method,combination method has higher identification rate,and could identify more SLNs.It is recommended that the combination of radiolabeled colloid and blue dye should be adapted for procedure of SLNB in clinical practice.