乳腺癌前哨淋巴结的临床研究

目的：探讨前哨淋巴结活检（sentinel lymph node biopsy，SLNB）在乳腺癌临床应用中的可行性、准确性。方法：术前肿瘤表面或活检腔周围皮内注射99mTc-DX，进行前哨淋巴结（sentinel lymph node，SLN）显像、体表定位；术中r-探测仪识别SLN，先行SLNB，再行乳腺癌根治术或改良根治术，术后对SLN和腋窝淋巴结清扫（axillary Lymph Node Dissectio，ALND）的病理结果进行综合分析。结果：淋巴闪烁显像和r-探测器联合应用检测SLN准确率为96.9％，敏感度为90.9％，假阴性率为9.1％，假阳性率为0。结论：SLNB是乳腺癌治疗中的一项新技术，能高灵敏度反应腋淋巴结状态。     

99mTc-硫胶体术前淋巴显像在乳腺癌前哨淋巴结活检中的应用*

目的:探讨用99mTc- 硫胶体（99mTc-Sulfur colloid ,SC）术前淋巴显像在乳腺癌前哨淋巴结活检（sentinel lymph node biopsy ,SLNB）中的临床应用。方法:选择2009年7 月到2010年1 月本院收治的70例乳腺癌患者,于乳腺肿块周围3 点、6 点和12点位置各注射99mTc-Sc37MBq 后15min、30min、1h、2h 行前哨淋巴结（sentinel lymph node ,SLN ）显像,术中用γ 探针探测“热点”淋巴结分析术前淋巴显像与术中探测检测乳腺癌SLNB的结果。结果:术前99mTc-Sc 淋巴显像成功确定60例患者（85.71%）的前哨淋巴结,5 例患者（7.15%）发现腋窝以外的前哨淋巴结。淋巴显像确定SLN 的成功率与原发肿瘤病理类型、临床分期、肿瘤部位等因素无显著性相关（均P>0.05）;与注射同位素到显像的时间有显著相关性（均P<0.05）。 术中确定SLN 的成功率在术前淋巴显像成功组与失败组之间有统计学差异（P<0.05）。 结论:乳腺癌SLN 术前淋巴显像在乳腺癌前哨淋巴结活检中具有一定临床价值,99mTc-Sc对乳腺癌前哨淋巴结检测具有较高的检出率和导向性,能较好的指导手术方案的制定,值得临床推广。      

术前淋巴显像在乳腺癌前哨淋巴结活检中的作用

目的探讨术前淋巴显像在乳腺癌前哨淋巴结活检（sentinel lymph node biopsy，SLNB）中的作用。方法回顾性分析了716例联合术前淋巴显像与术中1探测仪和蓝染料检测乳腺癌SLNB的结果。结果全组SLNB成功率98．2％（703／716），验证组SLNB的假阴性率16．0％（15／94）。淋巴显像共成功地确定出620例患者（86．6％）的前哨淋巴结（sentinel lymph node，SLN），并在36例患者（5．0％）中发现了腋窝以外的前哨淋巴结。淋巴显像确定SLN的失败率与原发肿瘤的部位、肿瘤的病理类型和注射同位素到显像的时间无显著相关性（均P〉0．05）。注射示踪剂前已进行肿瘤切除活检的患者，其淋巴显像成功率低于未行肿瘤切除活检者；淋巴结转移患者淋巴显像的成功率低于淋巴结阴性患者。术中确定SLN的成功率在术前淋巴显像成功组和失败组之间存在显著的统计学差异（99．5％ vs 91．0％，P〈0．01）。术前淋巴显像是否成功确定SLN与SLNB的假阴性率无显著相关性（P=0．731）。结论乳腺癌SLN术前淋巴显像可以预测术中SLNB的成功率，同时术前淋巴显像有助于确定腋窝以外的SLN，但术前淋巴显像并非乳腺癌SLNB所必需。     

乳腺癌前哨淋巴结活检研究进展

近年来，乳腺癌前哨淋巴结（sentinel lymph node，SLN）研究发展迅速。一系列大样本、前瞻性临床试验证实了前哨淋巴结活检（sentinel lymph node biopsy，SLNB）的安全性。SLNB可以提供准确的腋窝淋巴结分期、SLN阴性患者SLNB替代腋清扫术腋窝复发率和并发症很低，为其提供了循证医学Ⅰ、Ⅱ级的证据。此外，目前的研究也证实SLNB中应用的放射性同位素对患者和医务人员是安全的。SLNB的适应证也在不断扩大。     

乳腺癌前哨淋巴结活检术中分子诊断的研究进展

乳腺癌前哨淋巴结（sentinel lymph node,SLN）能准确反映腋窝淋巴结的状况。前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）已成为临床腋窝淋巴结阴性早期乳腺癌患者的标准腋窝处理模式。准确、快速、客观的SLN术中诊断可以使SLN阳性患者通过一次手术完成腋窝淋巴结清除,避免二次手术带来的风险及并发症,为患者和术者节约了时间,降低了手术风险,并减少了二次手术带来的费用负担。近年来,术中分子诊断已成为乳腺癌SLN研究的热点之一。     

新型光声传感及成像系统探测乳腺癌前哨淋巴结的基础研究

背景与目的:前哨淋巴结活检(sentinel lymph node biopsy,SLNB)是临床淋巴结(lymph nodes,LN)阴性早期乳腺癌患者的标准分期技术,蓝染法联合核素法作为SLNB的标准方法仍有一定的局限性.应用新型荧光靶向示踪剂吲哚菁绿(indocyanine green,ICG)与利妥昔单抗(ri...     

乳腺癌新辅助化疗后前哨淋巴结活检的临床意义

目的探讨新辅助化疗后乳腺癌前哨淋巴结活检的可行性。方法对57例行^99Tc联合亚甲蓝示踪前哨淋巴结活检术和腋窝淋巴结清扫术乳腺癌患者的资料进行分析,其中31例ⅡB、Ⅲ期患者先行2～3个疗程新辅助化疗后再行前哨淋巴结活检及腋窝淋巴结清扫术,另26例Ⅰ、Ⅱ期患者直接行前哨淋巴结活检及腋窝淋巴结清扫术。结果新辅助化疗组和非新辅助化疗组平均腋窝淋巴结数、前哨淋巴结（sentinel lymph node,SLN）数、SLN检出率、SLN假阴性率均无显著差异（P均〉0．05）。新辅助化疗纽化疗前临床分期在N2以上者,SLN检出率均显著下降（P〈0．05）。结论新辅助化疗后前哨淋巴结活检能准确预测腋窝淋巴结的状况。化疗前的N分期是SLNB检出率的影响因素。     

新型荧光示踪剂在乳腺癌前哨淋巴结活检术中的应用研究

背景与目的：吲哚菁绿（indocyanine green,ICG）与利妥昔单抗（rituximab,Rit）偶联可使ICG在淋巴结显像中具有靶向性。探讨ICG-Rit用于乳腺癌前哨淋巴结活检（sentinel lymph node biopsy,SLNB）的可行性。方法：入组山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心96例原发性乳腺癌患者（100例次SLNB）。ICG与Rit质量比为93.75 μg∶375.00 μg。术前行ICG-Rit、联合示踪剂（亚甲蓝及核素示踪剂）乳房注射,联合法行SLNB,对检出淋巴结进行荧光显像检测,记录荧光显像淋巴结及灰度值,分析ICG-Rit淋巴结显像情况并评价对比联合法的一致性。观察患者过敏反应并检测术后嗜酸性粒细胞计数。结果：ICG-Rit病例显像率为97.0%（97/100）。ICG-Rit显像前哨淋巴结（sentinel lymph node,SLN）的均数为2.44,中位数为2;低于核素法检出SLN的均数（2.80）和中位数（3）。ICG-Rit对比联合法SLNB的准确率为97.0%（97/100）,灵敏度为96.2%（25/26）,假阴性率为3.8%（1/26）,kappa值为0.973（P＜0.001）。显像淋巴结灰度值最高254,显像淋巴结灰度值集中在220~254,＜220者术中荧光不易察觉,缺乏连续性。入组患者术前未见过敏反应,术后嗜酸性粒细胞计数未增高。结论：ICG-Rit能够减少对非SLN（non-SLN,n-SLN）的显像。对比联合法,准确率和符合率高,安全性良好。     

示踪用盐酸米托蒽醌注射液与核素用于乳腺癌前哨淋巴结活检的疗效对比研究

背景与目的：国内外指南均推荐核素用作前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）示踪剂，但多种原因导致该技术在国内未得到普及。示踪用盐酸米托蒽醌注射液（mitoxantrone hydrochloride injection for tracing,MHI）是一种新型乳腺癌前哨淋巴结（sentinel lymph node,SLN）示踪剂，其在乳腺癌SLNB中的效果尚未明确。本研究是一项大样本阳性对照临床试验，旨在评价MHI和核素在SLNB中的示踪差异。方法：试验纳入了2019年12月—2020年7家医院的早期乳腺癌患者。所有入组的早期乳腺癌患者均在手术前注射MHI和核素作为SLN示踪剂。分别统计MHI和核素的SLN检出数量和SLN检出率，分析两种示踪剂示踪效果的差异。结果：MHI的SLN检出率为96.9%(370/382)，核素的SLN检出率为97.4%(372/382)，两者检出率差异无统计学意义（P>0.05）。两种示踪剂共同检测到362例（94.7%）受试者的SLN;16例（4.1%）发生可能与试验药物相关的不良事件。结论：本研究发现...     

吲哚菁绿联合美蓝在乳腺癌腋窝前哨淋巴结活检的临床应用价值

目的:探讨吲哚菁绿（indocyanine green,ICG ）荧光导航法联合美蓝示踪法在乳腺癌腋窝前哨淋巴结活检（sentinel lymph node biopsy ,SLNB）中的临床应用价值。方法:收集2013年5 月至2014年4 月广东省汕头中心医院符合入组标准的89例早期乳腺癌患者。其中第一阶段,53例术中行ICG 联合美蓝注射,并利用淋巴荧光显像及美蓝示踪行前哨淋巴结活检术联合腋窝淋巴结清扫术（axillary lymph node dissection ALND ）;第二阶段,36例术中前哨淋巴结（sentinel lymphnode ,SLN ）冰冻病理阴性患者不再行腋窝淋巴结清扫。统计SLN 的检出成功率、准确率及假阴性率。结果:89例患者的SLN 检出成功率为96.6%（86/ 89）,第一阶段检出成功率为94.3%（50/ 53）、准确率98.0%（49/ 50）、假阴性率2.6%（1/ 38）,第二阶段检出成功率为100%（36/ 36）。 ICG 荧光导航法联合美蓝示踪法检出196 枚SLN 中荧光显示为179 枚,196 枚SLN 其中显示蓝染142 枚、未显示蓝染的54枚仅显示荧光。196 枚SLN 中有转移为45枚,5 枚仅显示荧光。22例患者SLN 转移,转移率为24.7%（22/ 89）,2 例患者的SLN 仅显示荧光而未蓝染。中位随访时间为25个月,未发现同侧区域淋巴结复发。结论:ICG 荧光导航法联合美蓝示踪法能够安全有效地应用于乳腺癌前哨淋巴结活检。      

Intradermal radioisotope injection optimises sentinel lymph node identification in breast cancer

AIM: Currently there is no consensus on the optimal technique for sentinel lymph node (SLN) identification in patients with breast cancer. The aim was to compare the efficacy of intraparenchymal and intradermal isotope injection in sentinel lymph node mapping for breast cancer. METHODS: One hundred and twenty-five patients with histologically confirmed invasive breast cancer underwent SLN mapping using radioisotope and isosulphan blue dye followed by a back-up axillary dissection. The first 80 patients had intraparenchymal (IP) injection of radioisotope given in four portions around the tumor. The remaining 45 patients had an intradermal (ID) injection given at a single site over the tumour. Both groups had isosulphan blue dye injected around the tumour. Sentinel node(s) were identified using a combination of lymphoscintigraphy, blue dye and an intra-operative hand held gamma probe. RESULTS: The preoperative lymphoscintigram (LSG) demonstrated a SLN significantly more often in the ID isotope group compared to the IP isotope group (P=0.002). A combination of blue dye and isotope successfully located the SLN in 96% of the intraparenchymal group and 100% of the intradermal group. CONCLUSION: Our results suggest that intradermal isotope injection in combination with intraparenchymal blue dye optimises the localization of the sentinel lymph node in breast cancer.     

Initial experience with sentinel lymph node mapping and biopsy in breast cancer. Preliminary results on 80 consecutive patients

Sentinel node biopsy, in breast cancer, is a promising surgical technique for predicting histological findings in the remaining axillary lymph nodes, especially in patients with clinically node-negative breast cancer. 80 patients with breast cancer were evaluated for enrollment in this study. For mapping procedure 32 patients underwent lymphoscintigraphy in combination with an injection of vital blue dye, while 48 utilized only vital dye. In all patients, after sentinel node (SLN) biopsy, a complete axillary dissection was performed. The mapping procedure was possible in 79 cases (98.7%). The SLNs were positive in 27 (34.1%), in 52 patients SLNs were negative and in 50 of these all axillary nodes were negative. There was concordance in 77/79 cases (97.4%). The false negative rate was 3.8% (2/52). The overall sensitivity of the SNL biopsy was 93.1% (27/29), with a negative predictive value of 96.1% (50/52). This study demonstrates that accurate SLN identification was obtained combining lymphoscintigraphy and blue dye. Moreover, each method requires a suitable learning curve. Further studies are needed to define an accurate patient selection and the most speedy and precise method for intraoperative histological examination of SLNs.     

核素淋巴显像识别前哨淋巴结在乳腺癌治疗中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌中确定前哨淋巴结(SLN)的应用价值,验证前哨淋巴结活检替代腋窝淋巴结清除术用于乳腺癌治疗的安全性与价值。方法选择1999年6月至2009年11月本院住院的女性乳腺癌患者206例(体检时腋窝均未扪及肿块),应用99Tcm-DX37～74 MBq或99Tcm-SC74 MBq经皮下注射,行核素淋巴显像后,术中注射专利兰1 ml和(或)术中用γ探针定位并行前哨淋巴结活检,与术中冰冻病理检查结果对照。若术中冰冻发现有前哨淋巴结转移,则行腋窝淋巴结清除术,若前哨淋巴结阴性,则不做腋窝淋巴结清除,术后定期随访。结果 206例乳腺癌术中成功活检SLN204例,成功率为99.0%(204/206)。本组有64例仅行SLN切除,术后病理检查证实64例SLN均阴性,故未行腋窝淋巴结清除,其中仅1例于术后1年时出现腋窝淋巴结转移,其余63例患者在随访期间均未发现腋窝淋巴结转移,也未出现同侧上肢水肿、感觉及活动异常;另140例行腋窝淋巴结清除,其中6例经病理证实SLN阳性但腋窝淋巴结为阴性,134例经病理证实SLN阳性35例,阴性99例,腋窝淋巴结阳性37例,阴性97例。核素淋巴显像和γ探针定位法的灵敏度为94.6%(35/37例),准确率为98.5%(138/140),假阴性为5.4%(2/37)。结论核素淋巴显像和γ探针定位应用于乳腺癌是切实可行和可能的,对预测腋窝淋巴结转移有很大的临床实用价值。如技术方法规范,早期乳腺癌前哨淋巴结活检则能取代常规的腋窝淋巴结清除术,乳腺癌手术上肢并发症的发生率可大大降低。     

美蓝法乳腺癌前哨淋巴结活检的手术配合

目的：探讨美蓝法乳腺癌前哨淋巴结活检技术（Sentinel lymph node biopsy，SLNB）的可行性及其与手术的配合。方法：本组32例T1、T2患者均先行乳腺区段切除，送快速冰冻病理活检，回报确诊为乳腺癌后于术中应用美蓝行前哨淋巴结活检，同时进行腋淋巴结清扫（Axillary lymph node dissection．ALND）。术后对全部前哨淋巴结（SLN）和腋淋巴结（ALN）行常规病理检查。结果：32例中检出SLN者29例，检出率为90．63％（29／32），本组准确率为84．38％（27／32）；灵敏度为91．67％（11／12），即预测符合率；假阴性率为16．67％（2／12）；假阳性率为0。结论：应用美蓝示踪定位SLNB，能准确预测T1、T2乳腺癌患者的腋淋巴结转移状况，与手术配合易于控制活检的时间，成功率较高。     

Sentinel lymph node biopsy in melanoma patients with clinically negative regional lymph nodes--one institution's experience

The purpose of this prospective study of sentinel lymph node (SLN) biopsy in a large series of melanoma patients with clinically negative regional lymph nodes from one cancer centre was to analyse the reliability of the procedure, the pattern of failures during follow-up and the factors affecting the clinical outcome of patients. Between April 1995 and November 2001, 726 consecutive patients with primary cutaneous malignant melanoma underwent SLN biopsy with preoperative lymphoscintigraphy. The vital blue dye technique was used in 170 patients, and the blue dye technique combined with intraoperative lymphoscintigraphy in 556 patients. The primary melanoma sites were head and neck in nine patients, the extremities in 419 patients, and the trunk in 298 patients. The median Breslow thickness was 3.0 mm. All patients were followed closely, the median follow-up time being 34 months. The sentinel node(s) were successfully identified in 96% of patients. Intraoperative lymphoscintigraphy combined with the blue dye technique improved the SLN identification rate (technical success in 97.3% of cases) compared with the blue dye technique alone (technical success in 91.6%). The rate of failed SLN procedures was significantly (P = 0.007) lower in inguinal basins (3.1%) compared with axillary basins (7.9%). SLN metastases were detected in 147 patients (20.2%). The presence of SLN metastases correlated significantly with primary tumour thickness and ulceration (P < 0.001). The false-negative SLN biopsy rate was 4.66% (27 out of 579 SLN-negative patients). All but two node-positive patients underwent complete lymphadenectomy. Lymph nodes other than SLNs were found to contain metastases in 26.9% of patients (39 out of 145). The 5 year overall survival (OS) rate was 84% for SLN-negative patients and 40% for SLN-positive patients. Five variables showed a strong, statistically significant negative independent prognostic association with OS: positive SLN status (P = 0.000001), primary melanoma thickness > 4 mm (P = 0.0009), male gender (P = 0.001), more than one lymph node involvement (P = 0.02) and lymph node extracapsular extension (P = 0.03). SLN biopsy is currently a valuable and effective diagnostic procedure for the precise staging of patients with clinically N0 cutaneous melanoma. So far SLN biopsy seems to be the only accessible method for consciously oriented detection of nodal micrometastases in melanoma that would otherwise go undetected. SLN status is the most important factor proven to distinguish high and low risk melanoma patients.     

核素淋巴显像法术中定位乳腺癌前哨淋巴结

目的　研究核素淋巴显像法术前显像和术中γ探测相结合定位活检乳腺癌前哨淋巴结(SLN)的临床应用价值。方法　 42例病理穿刺活检诊断为乳腺癌、肿块直径≤ 5.0cm、临床上腋淋巴结阴性的患者 ,术前在肿块或活检腔周围腺体内分 4点注射 18.5MBq/ 0 .5ml99mTc 硫胶体 (标记率 >98% ,胶体颗粒大小为 10 0～ 2 0 0nm) ,核素显像和术中γ探测仪定位活检乳腺癌SLN。所有患者行同期根治术 ,切除的SLN与区域清扫标本送常规病理检查。结果　乳腺癌SLN核素淋巴显像检出率为88.1% ,术中γ探测仪检出率为 97.6%。SLN的灵敏度为 93 .3 % (14 / 15) ,准确性为 97.6% (40 / 4 1) ,假阴性率为 6.7% (1/ 15) ,特异性为 10 0 % (2 6/ 2 6)。结论　核素淋巴显像法术前显像和术中γ探测相结合定位活检乳腺癌SLN能准确反映区域淋巴结的转移情况。改进核素显像剂品质、注射核素显像剂方式和探测方法 ,可提高定位活检SLN的检出率     

Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer

AIMS: To evaluate the feasibility and consequences of lymphatic mapping and a ("repeat") sentinel lymph node (SLN) procedure in patients with breast cancer relapse after previous breast and axillary surgery. METHODS: Review and presentation of a patient cohort. All SLN procedures included lymphoscintigraphy and blue dye injection technique. RESULTS: Twelve cases are described: two patients after a previous SLN procedure and ten after a previous complete axillary lymph node dissection (ALND). Ten patients (83%) had a successful repeat SLN biopsy. After previous ALND, lymphoscintigraphy revealed drainage towards the internal mammary chain in three patients, and contralateral axillary drainage in four. Based on the information from the "repeat" SLN biopsy further treatment strategy was altered in seven of the 12 patients. CONCLUSION: Lymphatic mapping and (repeat) SLN biopsy is possible and can be informative in patients who present with a relapse of breast cancer after previous surgery for primary breast cancer.     

Sentinel lymph node biopsy in breast cancer using blue dye with or without isotope localization

BACKGROUND: The purpose of this study was to determine the feasibility of sentinel lymph node (SLN) biopsy using blue dye with or without isotope localization to predict the presence of axillary and internal mammary lymph node (IMN) metastases in patients with breast cancer. We also investigated whether multiple sectioning of the SLN could improve the accuracy of frozen section examination. METHOD:One-hundred twenty-six patients underwent dye-guided or dye- and gamma probe-guided SLN biopsy followed by complete axillary lymph node dissection (ALND). No ALND was performed in the 14 patients with small tumors and a negative SLN. In addition, 69 patients underwent IMN biopsy. RESULTS: The axillary SLN was identified in 123 of 140 (88%) patients. An accuracy rate of 90% was obtained by frozen section examination of the SLN, which increased to 100% in patients examined with a greater number of sections. Lymphatic flow to the IMN and/or a radioactive hot spot in the IMN was found in 9 of 102 (9%) patients, while a hot node was detected using a gamma probe in only 2 of these patients. No involvement of the IMNs was found histologically in these 9 patients. IMN involvement was found in 7 of 61 (11%) patients without lymphatic flow to the IMNs or a hot spot by lymphoscintigraphy or who did not undergo lymphoscintigraphy. CONCLUSION: ALND can be avoided in patients with small breast cancers and a negative SLN. SLN biopsy guided by lymphatic mapping is unreliable for identifying metastases to IMNs.     

淋巴显像在乳腺癌前哨淋巴结活检中的应用

目的：评价淋巴显像在乳腺癌前哨淋巴结活检中的价值。方法：采用肿瘤周围或皮下注射^99mTc标记的硫胶体的方法,先行术前淋巴显像,术中γ探测仪引导下行前哨淋巴结活检,分析影响其检出率的相关因素。结果：95例患者中,有88例（92．6％）在术前的淋巴显像中显示淋巴引流,其中39例（44．3％）患者有腋窝淋巴结以外的淋巴外流。术中在γ探测仪引导下成功发现前哨淋巴结的有91例（95．8％）。术前淋巴显像是清楚与前哨淋巴结检出率显著相关（P＝0．025）。结论：淋巴显像能发现腋窝以外的前哨淋巴结,联合使用淋巴显像与γ探测仪行前哨淋巴结活检的方法是可行的,值得在临床上推广使用。