食管癌胃周淋巴引流的示踪研究

目的:评价用纳米碳行食管癌示踪胃周淋巴引流的可行性,探讨食管癌胃周淋巴引流及胃周转移的特点.方法:40例食管癌手术病人术中在肿瘤下方食管外膜下注射纳米碳混悬液,即时观察淋巴管显影情况.切除标本解剖胃周淋巴结,记录染色淋巴结,剖视标本观察食管粘膜下及胃粘膜下淋巴管着色情况.淋巴结分组送病理HE检查.结果:纳米碳悬液注射后可见食管外膜下及胃小弯组织中淋巴管黑染,32例64枚胃周淋巴结黑染,6例8枚贲门旁淋巴结着色黑染,32例52枚胃左动脉干旁淋巴结黑染,4例4枚胃左动脉第1分支动脉旁淋巴结黑染.4例4枚黑染胃左动脉干旁淋巴结查见癌转移.剖视见食管粘膜下广泛分布染黑的网状淋巴管,胃粘膜下未见着色黑染的淋巴管.结论:纳米碳混悬液可用于食管癌胃周淋巴转移的示踪研究,食管腹腔淋巴引流最常引流至胃左动脉旁淋巴结.     

染料引导下胃癌淋巴清除术的临床应用

目的:探讨纳米炭示踪胃癌前哨淋巴结的临床价值.方法:48例胃癌患者随机分为实验组(n=24)和对照组(n=24).实验组,术中注入纳米炭混悬液(CNP),标记后行胃癌根治术.对照组,未标记直接行胃癌根治术.结果:实验组原发灶平均直径为3.1 cm,黑染淋巴结22例(91.67％),共清除淋巴结673枚,平均每例28.04枚,第2、3站淋巴结清除数分别为305和182枚,平均12.71和7.58枚;对照组共清除淋巴结445枚,平均每例18.54枚,第2、3站淋巴结清除数分别为178和86枚,平均7.42和3.58枚.实验组和对照组淋巴结转移率分别为62.5％和33.3％,差异有统计学意义,P＜0.05.实验组清除的淋巴结中黑染度为58.10％(391/673).第1站为41.94％(78/186),第2和3站为61.97％(189/305)和68.13％(124/182),第1站与2和3站差异有统计学意义,x2 =37.85,P＜0.01.结论:胃癌根治术中应用纳米碳能增加淋巴结清除数目,使根治术更加彻底.     

不同示踪剂在早期宫颈癌前哨淋巴结定位中的临床应用

目的 对比分析纳米炭与亚甲蓝在早期宫颈癌前哨淋巴结定位中的应用效果,为临床示踪剂选择提供参考.方法 选择确诊为早期宫颈癌的60例患者作为研究对象,采用数字随机表法分为纳米炭示踪组和亚甲蓝示踪组,每组30例.两组患者均于手术同期行前哨淋巴结活检,纳米炭示踪组患者采用纳米炭作为示踪剂,亚甲蓝组采用亚甲蓝作为示踪剂,两组患者均行腹腔镜或开腹手术,术中切除探查前哨淋巴结,亚甲蓝组患者蓝染淋巴结为前哨淋巴结,纳米炭组患者以黑染淋巴结为前哨淋巴结,均予以切除.术中行广泛切除全子宫及淋巴结清扫术,同时于腹主动脉旁取样淋巴结,术中均采用快速冰冻切片法和组织免疫法对前哨淋巴结、清扫的所有淋巴结及腹主动脉旁淋巴结进行病理检测.结果 30例亚甲蓝示踪组患者中切除淋巴结254个,共检出前哨淋巴结38个,SLN肿瘤转移2枚,病理检查肿瘤转移5枚;纳米炭示踪组患者切除淋巴结261个,前哨淋巴结检出44个,SLN肿瘤转移4枚,病理检测肿瘤转移4例.纳米炭示踪组前哨肖淋巴结检出率明显高于亚甲蓝示踪组(P＜0.05),两组患者的定位分布构成比比较差异无统计学意义(P＞0.05).亚甲蓝示踪组检出前哨淋巴结转移的敏感性为33.3％、准确性为80.0％、特异性为87.5％.纳米炭示踪组检出前哨淋巴结转移的敏感性为80.0％、准确性为86.7％、特异性为88.0％.结论 纳米炭宫颈注射进行宫颈恶性肿瘤前哨淋巴结的检测技术优于亚甲蓝,是临床可行的,但还需要大量的临床研究进一步证实.     

腋窝逆向淋巴结示踪术在乳腺癌患者选择性腋窝淋巴结清扫中的应用

目的探讨乳腺癌患者行选择性腋窝淋巴结清扫术时,通过施行腋窝逆向淋巴结示踪术(ARM)来保留引流上肢淋巴液的淋巴结的可行性。方法根据纳入、排除标准,选取南京医科大学第一附属医院乳腺外科2015年4—7月拟行腋窝淋巴结清扫术的80例女性乳腺癌患者进行前瞻性研究。用纳米炭混悬液行ARM,以胸背血管和腋静脉为界,将腋窝淋巴结分为3区:腋静脉上方区、胸背血管外侧区、胸背血管内侧区。通过病理分析淋巴结有无转移。结果 80例患者中,72例(90%)患者可显示黑染淋巴结,40例患者有腋窝淋巴结转移。在40例腋窝淋巴结转移患者中,纳米炭混悬液注射距手术开始时间6 h的N_1和N_2期患者共14例,腋静脉上方淋巴结转移率为0/8,胸背血管外侧淋巴结转移率为0/11,胸背血管内侧转移率为5/11;而注射时间≥6 h的N_1、N_2期患者共15例,腋静脉上方淋巴结转移率为0/6,胸背血管外侧淋巴结转移率为3/11,胸背血管内侧转移率为7/11。在胸背血管外侧和腋静脉上方,引流上肢淋巴液的淋巴结转移率很低。结论 N_1、N_2期乳腺癌患者术前6 h内用纳米炭混悬液行ARM,胸背血管外侧和腋静脉上方淋巴结予以保留的价值可能较大。     

术中淋巴结示踪定位技术对进展期胃癌淋巴清扫指导作用的研究

目的探讨术中淋巴结示踪定位技术对进展期胃癌淋巴清扫的指导作用。方法术中肿瘤周围注射第三代淋巴结示踪剂——纳米炭混悬液,在D2根治术的基础上以黑染淋巴结为导向进行个体化清扫。统计清扫淋巴结的数目及淋巴结转移情况、黑染情况,并观察不良反应及并发症的发生。结果本组平均每例清扫淋巴结（35.1±13.4）枚,其中阳性淋巴结（6.9±2.5）枚;淋巴结黑染率为52.7%,黑染淋巴结中发生转移的阳性率（27.6%）,高于未黑染淋巴结（10.8%）,差异有统计学意义（χ2=6.034,P=0.016）;本组发生1例输入襻梗阻。结论进展期胃癌在D2根治术的基础上以术中淋巴显影技术为指导进行个体化清扫,能增加淋巴结清扫的彻底程度,并可提高清扫转移淋巴结的效率,但肿瘤进展程度会影响淋巴显影效果。     

纳米活性炭在胃癌根治术中的临床应用研究

目的评价纳米活性炭在胃癌根治术中的淋巴示踪作用。方法 80例胃癌患者随机分为示踪组(n=40)和对照组(n=40),示踪组患者术中于癌灶外0.5~1 cm浆膜下注射纳米活性炭进行胃周淋巴结示踪,对照组患者直接手术,比较两组清扫淋巴结的数目、淋巴结黑染数目。结果示踪组患者每例清扫淋巴结(38.3±3.1)枚,明显高于对照组的(17.3±1.2)枚,P<0.05。示踪组患者淋巴结的黑染率为79.84%(1220/1528),在经病理证实有转移的312枚淋巴结中,黑染的淋巴结数目为189枚(黑染率60.58%);未黑染的淋巴结数目为123枚(39.42%),两者差异有统计学意义(P<0.05)。结论采用纳米活性炭示踪剂可有助于胃癌根治术中辨认淋巴结,增加清扫淋巴结的数目,从而加强淋巴结清扫的彻底性,对改善患者的预后有重要意义。     

术前应用纳米活性炭对腹腔镜胃癌根治术治疗效果及淋巴结清扫的影响

目的 探讨术前应用纳米活性炭对腹腔镜胃癌根治术治疗效果及淋巴结清扫的影响.方法 选择88例胃癌患者,根据随机数字表法分为两组,每组44例.所有患者均接受腹腔镜胃癌根治术联合D2淋巴结清扫术治疗,研究组术前应用纳米活性炭混悬液注射,对照组不应用纳米活性炭混悬液.比较两组淋巴结清扫情况、术后肿瘤复发率、淋巴结转移率、死亡率和并发症发生率.结果 对照组共清扫1257枚淋巴结,研究组共清除1730枚淋巴结,其中1007枚黑染淋巴结,黑染率为58.21％.研究组清扫平均淋巴结数和平均微小淋巴结数均明显多于对照组,差异均有统计学意义(P<0.01);对照组平均淋巴结转移数目为(3.47±3.41)枚,研究组平均淋巴结转移数目为(7.52±4.93)枚,差异有统计学意义(P<0.01);对照组淋巴结转移率为14.88％(187/1257),研究组淋巴结转移率为19.13％(331/1730),黑染淋巴结转移率为23.14％(233/1007),研究组淋巴结转移率与黑染淋巴结转移率均明显高于对照组淋巴结转移率,差异均有统计学意义(P<0.01);两组患者肿瘤复发率与死亡率比较,差异均无统计学意义(P>0.05).研究组中未出现与纳米活性炭相关的不良反应;对照组和研究组术后肺部感染、切口感染、肠梗阻、胃瘫并发症发生率比较,差异均无统计学意义(P>0.05).结论 对行腹腔镜胃癌根治术患者术前应用纳米活性炭安全性较高,能有效提高总淋巴结、微小淋巴结以及转移淋巴结清扫数目,降低腹腔镜胃癌根治术中淋巴结的清除难度,利于改善患者预后及生活质量.     

示踪甲状腺乳头状癌侧颈淋巴结的前瞻性研究

  目的  探索在甲状腺乳头状癌中纳米炭示踪侧颈部淋巴结的应用价值。  方法  前瞻性地入组2016年3月至2017年11月复旦大学附属肿瘤医院接受甲状腺癌手术患者,术前超声或CT提示侧颈部淋巴结可疑转移,术中应用纳米炭混悬注射液进行侧颈部淋巴结示踪。  结果  共67例患者接受了70例/侧颈部淋巴结示踪手术,侧颈部淋巴结转移57例(81.4%)。炭阳性淋巴结的中位检出数量为6枚。Ⅳ区炭染淋巴结无论在送检例数、送检淋巴结枚数以及转移淋巴结比例均为最高。Ⅲ~Ⅳ区淋巴结中炭阳性淋巴结的转移比例显著高于炭阴性淋巴结(P < 0.001)。将最终颈清扫结果作为金标准,计算Ⅲ~Ⅳ区炭阳性淋巴结活检敏感度为86.0%。  结论  纳米炭是甲状腺癌侧颈部淋巴结示踪的潜在方法。联合侧颈部Ⅲ~Ⅳ区炭阳性淋巴结活检,可以达到较高的敏感度,是较为合理的前哨淋巴结活检范围。      

纳米碳在子宫内膜癌前哨淋巴结检测中的应用

目的:探讨纳米碳在子宫内膜癌前哨淋巴结检测中的可行性及应用价值。方法:选择25例经手术治疗的子宫内膜癌患者,术中于子宫前壁、后壁、宫底两侧共4点处注射纳米碳混悬液,识别黑染的淋巴结,并记录前哨淋巴结相关信息,淋巴结分开单独送病理检查行HE染色。结果:25例子宫内膜癌患者均出现子宫浆膜面黑染,前哨淋巴结检出率为84%（21/25）,共计114枚,其中盆腔双侧检出率为81%,盆腔一侧检出率为19%。3例患者发生淋巴结转移,均为SLN转移。结论:纳米碳作子宫内膜癌前哨淋巴结的示踪剂具有可行性,对于子宫内膜癌淋巴结转移判断有一定的临床应用价值。     

纳米炭在结直肠癌术中淋巴示踪的应用

[目的]探讨纳米炭淋巴示踪剂在结直肠癌手术中的应用价值。[方法]将55例结直肠癌患者随机分为实验组(26例)和对照组(29例)。实验组于术中在癌旁周缘分4～6点浆膜下注射纳米炭注射液1ml,术中参考黑染的淋巴结适当调整淋巴清扫范围,解剖标本,取出淋巴结并依据黑染与否、淋巴结位置及大小分组,送检病理检查。[结果]标本中可见淋巴结有广泛的不同程度的黑染,实验组平均每例检获的淋巴结数、淋巴结转移率、直径<3mm的淋巴结检出率等均显著高于对照组;区域外黑染淋巴结取出活检均呈阴性。[结论]术中应用纳米炭注射液能明显提高淋巴结检获的数量,最大可能地清除转移的淋巴结,指导病理分期,同时清扫范围外的黑染淋巴结均呈阴性,对结直肠癌过大范围的淋巴清扫提出疑问,因此对结直肠癌的淋巴清扫术有一定的指导意义。     

乳腺癌淋巴结转移规律对术后放射治疗设野的影响

目的 探讨乳腺癌淋巴结转移规律和乳腺癌根治术后放射治疗的适应证及照射范围。方法 行选择性胸膜外式乳腺癌扩大根治术78例,分析其中资料完整的61例,探讨内乳淋巴结的转移情况。非选择性乳腺癌根治术 锁骨上淋巴结清扫术46例,术前检查锁骨上淋巴结均为阴性,将锁骨上淋巴结及腑窝淋巴结分别标记为S及L1、L2、L3送检。行乳腺癌根治术412例,标记出L1、L2、L3淋巴结分别送检,用以分析腋窝淋巴结跳跃式转移的规律。结果 内乳淋巴结总的转移率为24.6%,其中腋窝淋巴结转移者,内乳淋巴结转移率为36.7%,而腋窝淋巴结无转移者,内乳淋巴结转移率为12.9%,转移部位仅限于1、2、3肋间。锁骨上淋巴结跳跃式转移率为3.8%;腋窝淋巴结的跳跃式转移率为8.1%。结论 乳腺癌淋巴结转移有其内在规律,乳腺癌根治术后照射野可以依据其区域淋巴结的转移规律进行修改,照射内乳区淋巴结时可以不必常规包括4、5肋间。当腋窝淋巴结仅有L1、L2组转移而无L3组转移时,锁骨上淋巴结区也可以不予照射。     

Lymphatic mapping and sentinel lymphadenectomy in early stage breast carcinoma

The rate of axillary lymph node metastases is low in early stage breast carcinoma and axillary lymph node dissection is controversial in the treatment of these patients. Intraoperative lymphatic mapping technique is suggested for the identification of metastatic lymph nodes. Intraoperative lymphatic mapping was performed on 60 clinical stage I and II patients who were treated at Ankara Oncology Hospital between 1996-1998. Patent blue dye was injected in all cases, as the tumor was totally excised before mastectomy, into the surrounding breast tissue at four different quadrants. Presence of metastases were examined on stained lymph nodes (sentinel lymph node: SLN) by frozen-section. Modified radical mastectomy was performed including level I, II, III lymph node dissection. Metastases were evaluated on the remnants of frozen-section tissues and unstained lymph nodes (nonsentinel lymph node: nSLN) in axilla on hematoxyline-eosin stained slides and by immunohistochemistry. Forty-nine (81.6%) SLNs were identified among 60 cases. In 18 (36.7%) of these 49 patients, metastases were detected in SLNs by frozen section. In one case micrometastasis was detected in the remnants of frozen-section by immunohistochemistry though it was negative with hematoxyline-eosin. There were no metastases in nSLNs of 27 cases whose SLNs's frozen-sections were tumor free. In 3 cases SLNs were negative but metastases were detected in nSLNs (false negative: 6.1%). There were no local or systemic complications due to injections of dye. Selective lymph node dissections can be performed on early stage breast cancer patients by means of lymphatic mapping. This minimally invasive technique identifies metastatic axillary lymph nodes with a high degree of accuracy, so we can suggest that, non-metastatic patients can be treated without axillary dissection.     

The pattern of lymphatic metastasis of breast cancer and its influence on the delineation of radiation fields

PURPOSE: The delineation of radiation fields should cover the clinical target volume (CTV) and minimally irradiate the surrounding normal tissues and organs. This study was designed to explore the pattern of lymphatic metastasis of breast cancer and indications for radiotherapy after radical or modified radical mastectomy and to discuss the rational delineation of radiation fields. METHODS AND MATERIALS: Between September 1980 and December 2003, 78 breast cancer patients receiving extended radical mastectomy in the Margottini model and 61 cases with complete data were analyzed to investigate the internal mammary lymphatic metastatic status. Between March 1988 and December 1988, 46 patients with clinical negative supraclavicular nodes received radical mastectomy plus supraclavicular lymph node dissection. The supraclavicular lymph nodes and axillary lymph nodes were labeled as S and levels I, II, or III, respectively, and examined pathologically. Between January 1996 and April 1999, 412 patients who had radical or modified radical mastectomy underwent the pathologic examination of axillary or levels I, II, or III nodes. RESULTS: The incidence of internal mammary lymph node metastasis was 24.6%. It was 36.7% for the patients with positive axillary lymph nodes and 12.9% for the patients with negative axillary lymph nodes. All the metastatic internal mammary lymph nodes were located at the first, second, and third intercostal spaces. Skipping metastasis of the supraclavicular and axillary lymph nodes was observed in 3.8% and 8.1% of patients, respectively. CONCLUSIONS: According to our data, we suggest that the radiation field for internal mammary lymph nodes should exclude the fourth and fifth intercostal spaces, which may help to reduce the radiation damage to heart. It is unnecessary to irradiate the supraclavicular lymph nodes for the patients with negative axillary level III nodes, even with positive level I and level II nodes.     

1枚前哨淋巴结阳性早期乳腺癌保腋窝的可行性分析

目的探讨1枚前哨淋巴结（sentinel lymph node,SLN）阳性的早期乳腺癌患者保腋窝（omitting axillary dissection,OAD）的可行性。方法用美蓝作为示踪剂先行乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）,根据快速冰冻病理结果分为SLN阴性组与1枚SLN阳性组,随后两组均行常规腋窝淋巴结清扫（axillary lymph node dissection,ALND）以解剖出非前哨淋巴结（non—sentinellymphnode,NSLN）,比较两组间NSLN的阳性率。结果SLN阴性组30例,1例NSLN阳性,阳性率为3．3％,准确性为96．7％（29／30）;1枚SLN阳性组30例,仅3例NSLN阳性,阳性率为10．0％;两组阳性率差异无统计学意义（X^2=1．071,P=0．612）。全组随访1～48个月,均无区域淋巴结复发。结论1枚SLN阳性的早期乳腺癌患者可考虑OAD。     

Interest of periareolar injection for colorimetric detection of sentinel node in breast cancer

Most teams working on sentinel node biopsy in the treatment of breast cancer inject either radioactive colloid or vital blue dye around the primary tumour. Many anatomical studies and lymphoscintigraphical studies, some very old, have shown that the lymphatic drainage of the breast is collected first in the periareolar plexus of Sappey, then routed to the axilla in 95% of cases, via one or two primary collectors. In a series of 94 breast cancers measuring less than 3 cm, with any palpable axillary lymph node, 2 ml of patent blue was injected intradermally around the areola, at the two meridians around the tumor. The sentinel node was identified in 89 cases (94,7%), regardless of the location of the primary tumor. All the sentinel nodes were located in the lower axilla. An average of 1.6 nodes were found per patient. In 41 cases, axillary lymph node dissection was performed either immediately (5 technical failures, 9 positive frozen section) or delayed only if the sentinel node was positive, either on standard H&E staining or on immunohistochemistry (27 cases). Thus, axillary lymph node dissection was not performed in 48 patients (55%). In positive node patient, the sentinel node was the only positive lymph node in 20 patients (55%). For 5 positive node patients, axillary lymph node dissection was not performed: poor vital status (2 micro-metastatic nodes) or by decision of patient (3 IHC positive nodes). With this periareolar injection procedure, the rate of detection is highly satisfactory and is comparable to that usually published with peritumoral injection. This procedure seems appropriate in all cases, regardless of the topography, the size or the multifocality of breast cancer.     

新辅助化疗对腋窝淋巴结数量影响随机对照临床研究

目的：探讨新辅助化疗（neoadjuvant chemotherapy,NAC）对乳腺癌患者腋窝淋巴结数量的影响。方法：2010—03—02—2012—06—30临沂市人民医院乳腺外科收治82例临床Ⅱ～Ⅲ期乳腺癌患者,随机数字表法分为化疗组40例和手术组42例,化疗组以蒽环类CEF或EC方案行3～4个周期NAC,手术组直接接受乳腺癌改良根治术,比较两组患者的腋窝淋巴结数量。结果：40例经NAC的乳腺癌患者中,目标病灶完全缓解（CR）6例,部分缓解（PR）19例,病情稳定（SD）15例,无患者出现疾病进展（PD）。腋窝淋巴结清除以后,化疗组平均检出淋巴结总数为16．7枚（8～28枚）,手术组为20．4枚（12～37枚）;平均阳性淋巴结数化疗组为2．1枚（0～13枚）,手术组为6．5枚（0～20枚）,两组间差异均有统计学意义,P值均〈0．001。结论：乳腺癌患者接受NAC以后,进行腋窝淋巴结清除时,不仅阳性淋巴结减少,得到的淋巴结总数也减少。     

Initial experience with sentinel node biopsy in breast cancer at the National Cancer Center Hospital East

BACKGROUND: Axillary lymph node dissection is an important procedure in the surgical treatment of breast cancer. Axillary lymph node dissection is still performed in over half of breast cancer patients having histologically negative nodes, regardless of the morbidity in terms of axillary pain, numbness and lymphedema. The first regional lymph nodes draining a primary tumor are the sentinel lymph nodes. Sentinel node biopsy is a promising surgical technique for predicting histological findings in the remaining axillary lymph nodes, especially in patients with clinically node-negative breast cancer, and a worldwide feasibility study is currently in progress. METHODS: Intraoperative lymphatic mapping and sentinel node biopsy were performed in the axilla by subcutaneous injection of blue dye (indigocarmine) in 88 cases of stage 0-IIIB breast cancer. Sentinel lymph nodes were identified by detecting blue-staining lymph nodes or dye-filled lymphatic tracts after total or partial mastectomy. Finally, axillary lymph node dissection was performed up to Levels I and II or more. RESULTS: Sentinel lymph nodes were successfully identified in 65 of the 88 cases (74%). In the final histological examination, the sentinel lymph nodes in 40 cases were negative, including four cases with non-sentinel-node-positive breast cancer (specificity, 100%; sensitivity, 86%). In nine (31%) of the 29 cases with histologically node-positive breast cancer, the sentinel lymph nodes were the only lymph nodes affected. Axillary lymph node status was accurately predicted in 61 (94%) of the 65 cases. CONCLUSIONS: Although it was the initial experience at the National Cancer Center Hospital East, sentinel node biopsy proved feasible and successful. This method may be a reasonable alternative to the standard axillary lymph node dissection in patients with early breast cancer.     

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。     

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic-histologic correlation

BACKGROUND: Fine-needle aspiration (FNA) cytology of axillary lymph nodes is a simple, minimally invasive technique that can be used to improve preoperative determination of the status of the axillary lymph nodes in patients with breast cancer, thereby serving as a tool with which to triage patients for sentinel versus full lymph node dissection procedures. The aim of the current study was to determine the sensitivity and specificity of FNA cytology to detect metastatic breast carcinoma in axillary lymph nodes. METHODS: A total of 115 FNAs of axillary lymph nodes of breast cancer patients with histologic follow-up (subsequent sentinel or full lymph node dissection) were included in the current study. The specificity and sensitivity, as well as the positive and negative predictive values, were calculated. RESULTS: The positive and negative predictive values of FNA cytology of axillary lymph nodes for metastatic breast carcinoma were 1.00 and 0.60, respectively. The overall sensitivity of axillary lymph node FNA in all the cases studied was 65% and the specificity was 100%. The sensitivity of FNA was lower in the sentinel lymph node group than in the full lymph node dissection group (16% vs 88%, respectively), which was believed to be attributable to the small size of the metastatic foci in the sentinel lymph node group (median, 0.25 cm). All false-negative FNAs, with the exception of 1 case, were believed to be the result of sampling error. There was no 'true' false-positive FNA case in the current study. CONCLUSIONS: FNA of axillary lymph nodes is a sensitive and very specific method with which to detect metastasis in breast cancer patients. Because of its excellent positive predictive value, full axillary lymph node dissection can be planned safely instead of a sentinel lymph node dissection when a preoperative positive FNA result is rendered. .