乳晕下亚甲蓝法乳腺癌前哨淋巴结活检术169例应用报告

目的探讨乳晕下注射亚甲蓝示踪法进行前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)在乳腺癌治疗中的意义。方法 2005年1月～2010年3月,对169例(年龄33～70岁,中位年龄45岁)临床腋窝淋巴结阴性的乳腺癌术中乳晕下注射亚甲蓝2 ml行SLNB。SLN病理为阴性的患者,SLNB替代腋窝淋巴结清扫术。结果 163例(96.4%)成功实施SLNB,6例(3.6%)术中未能发现SLN,立即改行腋窝淋巴结清扫术(axillary lymph node dissection,ALND)。行SLNB的163例中,23例术中冰冻报告SLN癌转移,即行ALND;140例冰冻切片检查SLN未见癌转移。6例术后HE染色检查发现SLN存在1枚微转移淋巴结,5例接受ALND,1例拒绝行腋窝淋巴结清扫。135例SLNB代替ALND者中位随访时间16个月(3～62个月),均未发现腋窝淋巴结转移。结论亚甲蓝法SLNB安全、有效、简便易行,SLNB阴性的患者,可以替代ALND。     

前哨淋巴结活检的最新进展

近年来,一系列大样本、前瞻性的乳腺癌临床研究证实前哨淋巴结活检术（sentinel lymph node biopsy,SLNB）可以安全、准确地提供腋窝淋巴结分期,且乳腺癌前哨淋巴结（sentinel lymph node,SLN）阴性患者SLNB替代腋窝淋巴结清扫术（axillary lymph node dissection, ALND）后,     

前哨淋巴结快速活检在乳腺癌根治术中的意义

目的：探讨乳腺癌前哨淋巴结活检(sentinel lymph node biopsy，SLNB)的可行性和准确性，及其在乳腺癌手术中的临床应用价值。方法：对32例乳腺癌病人行SLNB，术中在肿瘤周边选二点注射1％美蓝5ml，根据肿块距腋窝的距离，5～10min后沿腋窝下皱折线切开，循蓝染淋巴管寻找前哨淋巴结(sentinel lymp hnode，SLN)。其中27例切除SLN后行腋窝淋巴结解剖(axillry lymph node dissection，ALND)，两标本同时送病理检查，了解其符合率，并评价SLNB的可行性。结果:全组均进行了SLNB识别定位，1例未取到SLN，检出率为96．9％；另一例SLN病理呈假阴性。按目前国外SLNB的评价标准，本组SLNB的敏感度为88．2％，准确性为96．9％，假阳性率为0，假阴性率为5．9％。结论:乳腺癌SLNB目前仍处于研究阶段，随着研究的深入与扩大，将成为早期乳腺癌的诊疗常规，阴性可避免ALND的痛苦。     

乳腺癌前哨淋巴结活检假阴性临床研究进展

<正>乳腺癌前哨淋巴结(sentinel lymph node,SLN)指接受乳腺癌引流的第一枚(或组)淋巴结,SLN阴性的病人免除腋淋巴结清扫(axillary lymph node dissection,ALND)可以降低腋窝手术的并发症发生率,并不增加腋窝淋巴结复发的危险[1-3]。前哨淋巴结活检(sentinel lymph node biopsy,SLNB)假阴性是指SLN未发现肿瘤累及而腋窝淋巴结却有转移灶的情况。Krag等[4]在NSABP B-32试验中对5379例乳     

乳腺癌新辅助化疗后前哨淋巴结活检的研究进展

在早期可手术乳腺癌病人中,前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)早已替代了传统的腋窝淋巴结清扫术(axillary lymph node dissection,ALND),使腋窝淋巴结(axilla-ry lymph node,ALN)阴性的病人减少了因腋清所导致的术后上肢肿...     

国产亚甲蓝行早期乳腺癌前哨淋巴结活检的观察

目的：探讨前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）反映早期乳腺癌腋淋巴结转移情况，并指导临床腋淋巴结阴性（cN0）乳腺癌腋窝淋巴结清除范围的可行性。方法：使用国产1％亚甲蓝对120例cT1.2N0M0期乳腺癌病人进行前哨淋巴结活检，于原发肿瘤边缘上、下、左、右选取4个注射点．将1％亚甲蓝4m1分别注射到乳腺实质及皮下组织内，已行术中活检则注射于残腔壁周围及其表面的皮下组织内。注射后从注射点向腋窝方向轻按摩5～10min，以利于淋巴管和淋巴结的染色，随后行乳腺癌改良根治手术或保乳手术。SLN常规HE染色病理检查．阴性者通过免疫组化方法行淋巴结微转移检查。结果：确定SLN87例，成功率为72．50％。SLNB的特异度为100％．假阳性率为0％，假阴性率为1．5％，准确率为98．85％；阴性前哨淋巴结的微转移率为4．44％。结论：前哨淋巴结转移状况基本上可反映乳腺癌腋淋巴结转移的状况；SLNB有望成为指导cN0，期乳腺癌腋淋巴结清除范围的方法。     

乳腺癌前哨淋巴结术中诊断研究进展

乳腺癌前哨淋巴结(sentinel lymph node,SLN)能准确反映患者腋窝淋巴结的状况,前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)替代腋淋巴结清扫术已成为临床腋淋巴结阴性早期乳腺癌患者的标准处理模式.通过对SLN进行快速、准确的术中诊断,SLN阳性的患者可以避免二次手术、减少精神创伤、降低医疗费用.     

纳米炭混悬液在乳腺癌前哨淋巴结活检中的应用分析

目的研究纳米炭混悬液(卡纳琳)在乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中的应用价值。方法回顾性分析我院乳腺外科收治的124例乳腺癌患者的临床资料,将其中100例乳腺癌患者随机分成2组,实验组50例,以纳米炭混悬液作为示踪剂;对照组50例,以放射性核素联合美蓝作为示踪剂。全部患者SLNB后常规行腋窝淋巴结清扫术(axillary lymph node dissection,ALND)。术后检验其检出率、准确率、灵敏度、假阴性率。另24例患者以纳米炭混悬液示踪行SLNB后,如前哨淋巴结(SLN)阳性,则继续行ALND;如SLN阴性,则"保腋窝"。根据患者选择术式的不同对比其手术效果及预后。结果实验组与对照组患者前哨淋巴结检出率、准确率、灵敏度、假阴性率比较,差异无统计学意义(P0.05)。结论纳米炭混悬液示踪SLNB可准确预测早期乳腺癌患者的淋巴结状态,较行ALND患者有更少的并发症。     

早期乳腺癌前哨淋巴结阴性患者行腋窝淋巴结清扫的预后分析

目的比较早期乳腺癌前哨淋巴结（SLN）阴性患者仅行前哨淋巴结活检术（SLNB）和SLNB后加腋窝淋巴结清扫术（ALND）的术后并发症及远期预后差异。 方法回顾性分析2005年1月至2010年12月461例SLN阴性的早期乳腺癌患者的临床和病理资料,其中241例仅行SLNB的患者为非腋窝淋巴结清扫组（NALND组）,220例加行ALND者为腋窝淋巴结清扫组（ALND组）。比较两组患者的术后并发症情况和远期疗效。 结果NALND组和ALND组术后平均住院天数为（5.2±1.3）d和（8.1±1.8）d（t=1.450,P=0.003）,术后6个月患侧上肢感觉异常分别为3.7%（9/241）和73.2%（161/220）（χ²=283.239,P<0.000 1）,患侧上肢水肿发生率分别为0（0/241）和10.9%（24/220）（χ²=7.735,P<0.000 1）,差异均有统计学意义。两组5年无病生存率分别为95.4%和95.5%（χ²=0.231,P=0.902）,差异无统计学意义。 结论对于SLN阴性早期乳腺癌患者,不行ALND较ALND手术创伤小,术后并发症少,且远期疗效可与ALND相媲美,本研究结论支持SLN阴性的早期乳腺癌患者无须进行ALND术。     

美蓝-核素联合法在乳腺癌患者前哨淋巴结活检中的应用

目的探讨美蓝一核素联合法在乳腺癌患者前哨淋巴结活检（sentinel lymph node biopsy SLNB）中的临床价值。方法以38例体检无腋窝淋巴结转移的乳腺癌患者为研究对象,在乳晕区注射99mTc标记的硫胶体,采用．y计数器探测仪结合美蓝染色法检测识别前哨淋巴结（sentinel lymph node SLN）,先行SLNB,随后行乳腺癌改良根治术。结果38例中2例未见淋巴结及淋巴管蓝染,总计共找到腋窝淋巴结507个,阳性18例131个,阴性20例376个：SLN共71个,阳性17例47个,阴性2l例24个。SLN的检出率94．6％,准确性94．4％,特异性100％。敏感性94．4％,假阴性率5．6％,假阳性率0。结论应用美蓝一核素联合法前哨淋巴结活检在乳腺癌治疗中可以取得较高的检出率和准确性．可用于确定是否行腋窝淋巴结清扫术。     

新型前哨淋巴结活检技术在选择性腋窝淋巴结清扫中的应用

目的 采用经前哨淋巴通道(SLC)行前哨淋巴结活检(SLNB)新技术,判断腋窝淋巴结状态及指导选择性腋窝淋巴结清扫(ALND).方法 采用非随机对照研究,通过前哨淋巴通道行SLNB.根据前哨淋巴结(SLN)的术中病理结果行选择性ALND的患者为A组,其中SLN为阳性,行ALND为A1组,SLN为阴性,仅行SLNB为A2组;无论SLN状态,SLNB后均行ALND的患者为B组.结果 2008年7月至2009年6月共114例早期乳腺癌患者行SLNB,检出i12例,A1组28例,A2组25例,B组59例.联合法和染料法检出率为分别为98.1%(102/104)和100.0%(10/10),两者差异无统计学意义(P>0.05).假阴性率为2.30%(2/87),假阳性率为0.89%(1/112).检出SLN1～4枚,共146枚,平均1.3枚.ALND组(A1+B)并发症发生率(52.9%)高于SLNB组(A2)并发症发生率(4.0%)(x~2=15.9675,P相似文献   

Clinical application of sentinel lymph node biopsy based on axillary anatomy in breast cancer: A single institution experience

BackgroundSentinel lymph node biopsy (SLNB), mostly with the use of vital dye or radioisotope, is a method for predicting axillary status in patients with breast cancer. Conventional axillary lymph node dissection (ALND) is used in cases where sentinel lymph node (SLN) is not detected by existing methods, but a series of studies have found that most of SLNs are present in specific anatomical spaces. We attempted to determine the feasibility of SLNB based on axillary anatomy in cases where SLN was not detected by conventional lymphatic mapping methods.MethodsA retrospective analysis involving 208 patients who received anatomical SLNB between January 2003 and December 2010 was performed. Lateral border of the pectoralis major muscle and lateral thoracic vein were defined as the anatomical landmarks, and ALND was performed to at least level II, regardless of the results of frozen section analysis. Pathologic results were used to measure false negative rate and accuracy. Chi-square test and Fisher's exact test were performed to find factors affecting results.ResultsFalse negative rate and accuracy of anatomical SLNB were 21.7% (13/60) and 93.3% (182/195), respectively. T stage, clinical node status, number of dissected SLNs and body mass index were analyzed as factors affecting results, but none of them was found as having a statistically significant influence.ConclusionThese results suggest that anatomical SLNB may not replace ALND in cases where SLN is not detected by conventional lymphatic mapping method, but may be considered as a method for predicting axillary status before conducting a node dissection.     

Clinicopathologic analysis of sentinel lymph node mapping in early breast cancer

Axillary nodal status is the most significant prognosticator for predicting survival and guiding adjuvant therapy in breast cancer patients. Sentinel lymph node biopsy (SLNB) represents a minimally invasive procedure with low morbidity for staging axillary nodal status. In this article we review and report our experiences in patients with early breast cancer who underwent SLNB at the Revlon/UCLA Breast Center. Between September 1998 and May 2000, a total 83 SLNBs were performed in 81 patients with proven breast cancer and negative axillary examination who elected to have SLNB as the first step of nodal staging. Two patients had bilateral breast cancer. SLNB was localized by using both 99Tc sulfur colloid (83 cases) and isosulfan blue dye (75 cases). Data of these patients were prospectively collected and analyzed. The clinical and pathologic characteristics of women with positive and negative sentinel lymph nodes (SLNs) were compared to identify features predictive of SLN metastasis. Of the 83 cases, the SLN was successfully localized in 82 (98.8%). Sixty-three percent of patients had SLNs found in level I only, 18.3% in both level I and II, and 4.9% in level II alone. The vast majority (84.3%) of these cases had T1 breast cancer with an average size of 1.55 cm for the entire series. Twenty-three patients (28%) had positive SLNs, with an average of 1.5 positive SLNs per patient. Fifteen had metastases detected by hematoxylin and eosin staining and 8 had micrometastases detected by immunohistochemistry (IHC) using anticytokeratin antibodies. Ten of the former group agreed to and 2 of the latter group opted for full axillary lymph node dissection (ALND). An average of 17.5 lymph nodes were removed from each ALND procedure. Additional metastases or micrometastases were found in seven patients (in a total of 28 lymph nodes). Three patients with completely negative SLNs experienced additional axillary lymph node removal due to their election of free flap reconstruction. None had metastases detected in these lymph nodes. The absence of estrogen and progesterone receptors (ER/PR) by IHC (p = 0.036) and the presence of lymphatic/vascular invasion (LVI) (p = 0.002) predicted positive SLNs in patients with early breast cancer in a univariate analysis; in a multivariate analysis only LVI was predictive (p = 0.0125). Histologic type, nuclear grade, tumor differentiation, HER-2/neu and p53 status, S-phase fraction, and DNA ploidy did not predict SLN status. Immediate postoperative complications were uncommon and delayed complications completely absent. Because of the high detection rate, accurate staging, and minimal morbidity, SLNB should be offered as a choice to women with small breast cancers and clinically negative nodes. Because positive LVI and negative ER/PR status are highly predictive of pathologically positive SLNs in small breast cancers, women whose cancers meet these criteria should be advised preoperatively about their risk of having a positive SLN and may benefit from intraoperative assessment (frozen section and/or touch preparation) of their SLNs.     

Solitary positive sentinel lymph node accompanied by negative sentinel lymph node(s) is predictive of a negative completion axillary lymph node dissection

BACKGROUND: Many patients with a positive sentinel lymph node (SLN) have a negative axillary lymph node dissection (ALND). We hypothesized that a solitary positive SLN associated with at least 1 negative SLN is predictive of a negative completion ALND. Omission of ALND may be possible in these patients. METHODS: A retrospective review of 392 consecutive patients who underwent SLNB was performed. The 78 (20%) SLN-positive patients were divided into 4 groups: group 1: solitary positive SLN associated with at least 1 negative SLN; group 2: more than 1 positive SLN with at least 1 negative SLN; group 3: solitary positive SLN with no additional SLNs; and group 4: more than 1 positive SLN and all SLNs positive. RESULTS: Excluding extracapsular extension, only 3% of group 1 patients had a positive ALND. Positive ALND was found in 15% of group 2, 29% of group 3, and 77% of group 4. CONCLUSIONS: A solitary positive SLN accompanied by additional negative SLN(s) is predictive of a negative completion ALND.     

前哨淋巴结检测在乳腺癌治疗中的意义

目的评价前哨淋巴结活检术 (sentinellymphnodebiopsy,SLNB)预测腋淋巴结肿瘤转移的准确性及其临床意义。方法使用专利蓝染色法和 /或99mTc标记的硫胶体示踪法对我院收治的81例乳腺癌患者进行前哨淋巴结活检。两种方法联合检测 3例前哨淋巴结 (sentinellymphnode ,SLN)均阴性者未行腋淋巴结清扫术。结果 81例患者SLN总检出率为 96 3% (78/81) ,总准确率为97 5 % ,总假阴性率 9 7%。 5 3例单纯染色法检出率为 92 5 % ,准确率 94 2 % ,假阴性率 15 8% ;2 8例99mTc示踪法和 /或染色法联合检测结果分别为 10 0 % ,10 0 %和 0。结论SLNB能够准确预测腋窝淋巴结的转移状况。两种方法联合检测为最佳。术前化疗对假阴性率可能有影响。     

Sentinel lymph node micrometastasis as a predictor of axillary tumor burden

The sentinel lymph node biopsy (SLNB) procedure is an alternative method for assessing the axillary lymph node (ALN) status in patients with breast cancer. The SLNB carries the risk of a false-negative result, with patients harboring positive ALNs in the face of a negative SLNB examination. In addition, the significance of a SLNB with cells identified only with keratin or with deposits less than 0.2 mm remains unresolved. We analyzed our SLNB data over the past 5 years in order to determine the relationship between SLN tumor burden and ALN tumor burden. Pathology files for the past 5 years at Magee-Womens Hospital were searched for all SLNB cases that had an axillary lymph node dissection (ALND). Each SLNB case was reviewed and tabulated for breast tumor size, SLN tumor size, and largest tumor size in the ALND. Correlation and frequency distribution were performed for the status of all SLNs and ALNDs. Patterns of lymph node metastasis were recorded and the sizes of the SLN metastases were reported according to the recent Philadelphia Consensus Conference on Sentinel Lymph Nodes and the revised American Joint Committee on Cancer (AJCC) staging. SLN metastases were classified as immunohistochemistry (IHC) positive if only single keratin-positive cells or clusters were present and were not observed with standard tissue stains, as submicrometastatic (SMM) if tumors were less than 0.2 mm (excluding IHC positive), as micrometastatic if tumors were larger than 0.2 mm but 相似文献   

美蓝染色法检测乳腺癌前哨淋巴结的临床研究

目的 寻找检测乳腺癌前哨淋巴结(SLN)方法，研究前哨淋巴结活检(SLNB)预测腋窝淋巴结状况的准确性。方法 对40例乳腺癌患者行美蓝染色法检测SLN，并行腋窝淋巴结清扫术(ALND)后，将腋窝淋巴结转移状况与SLN进行对比分析，分析SLN检出率及临床特征。结果 40例患者中成功检测出SLN35例，成功率为87．5％。检出SLN60个，平均每例检出SLNl．7个。2例出现假阴性，假阴性率为10.5％，无假阳性。35例患者中有16例SLN阳性，阳性率为45.7％。SLNB预测腋窝淋巴结(ALN)的敏感性为88．8％，特异性为100％，准确性为94．4％。结论 美蓝染色法检测乳腺癌SLN经济实用，可以较准确地预测腋窝淋巴结的转移状况。     

Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy

Axillary lymph node dissection (ALND) is the standard of care for nodal staging of patients with invasive breast cancer. Due to significant somatic and psychological side effects, replacement of ALND with less invasive techniques is desirable. The goal of this study was to evaluate the clinical usefulness of axillary lymph node (ALN) staging by means of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in breast cancer patients qualifying for sentinel lymph node biopsy (SLNB). FDG-PET was performed within 1 week before surgery in 24 clinically node-negative breast cancer patients with tumors smaller than 3 cm. Sentinel lymph nodes (SLNs) were identified by preoperative lymphoscintigraphy following peritumoral technetium 99m-labeled colloid albumin injection, and by intraoperative gamma detector and blue dye localization. Following SLNB, a standard ALND was performed. Serial sectioning and immunohistochemistry of the SLN as well as standard histologic examination of the non-SLN was performed. FDG-PET detected all primary breast cancers. Staging of ALNs by PET was accurate in 15 of 24 patients (62.5%), whereas PET staging was false negative in 8 of 10 node-positive patients and false-positive in 1 patient. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for nodal status was 20%, 93%, 67%, and 62%, respectively. The mean diameter of false-negative ALN metastases was 7.5 mm (range 1-15 mm). Lymph node staging using FDG-PET is not accurate enough in clinically node-negative patients with breast cancer qualifying for SLNB and should not be used for this purpose.