乳腺癌腔镜腋窝前哨淋巴结活检临床分析

目的：探讨乳腺癌腔镜下腋窝前哨淋巴结活检术（ESLNB）的临床可行性。 方法：选取2010年3月—2012年6月我院收治住院的45例早期乳腺癌患者。首先行ESLNB,所获前哨淋巴结送术中快速病理和术后病理检查,然后行腋窝淋巴结清扫术（ALND）,所获淋巴结送术后病理检查。评价ESLNB的灵敏度、准确率、假阴性率和假阳性率。将ESLNB与ALND对腋窝淋巴结转移情况的评估结果进行对比。 结果：成功检出前哨淋巴结43例,成功率为95.6％。ESLNB术中快速病理检查的灵敏度为90.1％,准确率为88.4％,假阴性率9.1％,假阳性率6.06％;ESLNB术后病理检查的灵敏度为93.9％,准确率为90.1％,假阴性率6.06％,假阳性率6.06％。ESLNB术中快速及术后病理检查与ALND术后病理检查对腋窝淋巴结转移状况的评估结果比较,无统计学差异（P>0.05）。 结论：亚甲蓝染色法行乳腺癌腔镜下腋窝前哨淋巴结活检术安全可行,为缩小乳腺癌的手术范围开辟了新的途径。     

乳腔镜前哨淋巴结活检术的临床应用

目的 探讨经乳腔镜前哨淋巴结活检的可行性及应用前景。方法 应用亚甲蓝染色法检测62例乳腺癌患者的前哨淋巴结(SLN)。在乳腔镜下切除SLN,随后行乳腔镜腋窝淋巴结清扫,SLN、腋窝淋巴结同时行HE染色,评价SLN检出率及假阴性率。结果 62例患者61例检出前哨淋巴结,成功率98．4％。无腋窝淋巴结转移者35例,转移27例,假阴性率0。结论 乳腔镜前哨淋巴结活检检出率高,美容效果好,并发症低,对于乳腺癌腋窝淋巴结转移有较高的敏感性,可以为绝大多数乳腺癌进行准确淋巴分期。     

吲哚菁绿分子荧光影像技术在乳腺癌单孔法腔镜前哨淋巴结活检术中的应用

目的:探讨吲哚菁绿(ICG)分子荧光影像技术在单孔法腔镜前哨淋巴结活检术中的应用价值。方法:选取2019年3月至2019年12月收治的行腔镜前哨淋巴结活检术的20例早期乳腺癌患者,均以ICG联合纳米碳混悬注射液作为示踪剂。手术切除的前哨淋巴结送术中冰冻病理检查及常规石蜡病理检查。比较前哨淋巴结检出率、前哨淋巴结转移数量及ICG单独显影、纳米碳单独显影、ICG+纳米碳同时显影的前哨淋巴结数量。结果:ICG、纳米碳、ICG+纳米碳前哨淋巴结检出率分别为100.0%、95.0%、100%;前哨淋巴结检出数量分别为89枚、77枚、97枚,前哨淋巴结检出数量平均为(4.45±1.86)枚、(3.85±1.98)枚、(4.85±2.22)枚,ICG组与纳米碳组差异有统计学意义(P<0.05),ICG+纳米碳组与纳米碳组之间差异亦有统计学意义(P<0.001)。20例患者中3例检出前哨淋巴结转移,转移前哨淋巴结7枚;7枚转移前哨淋巴结均被ICG检出,纳米碳仅检出其中2例患者共5枚转移前哨淋巴结。结论:ICG与单孔法腔镜前哨淋巴结活检术结合应用,具有较高的前哨淋巴结检出率及淋巴结检出数量,且前哨淋巴结假阴性率可能较低。     

乳腺癌前哨淋巴结活检对腋窝淋巴结转移的预警价值研究

目的探讨乳腺癌前哨淋巴结(sentinel lymph node,SLN)预警腋窝淋巴结转移的价值. 方法对56例乳腺癌行亚甲蓝前哨淋巴结定位、活检和腋窝淋巴结清扫术,标本常规行HE染色、免疫组化病理检查. 结果 SLN成功检出52例(52/56,92.8%),常规病理检查证实SLN转移22例;SLN无转移,但非SLN发现转移者1例,假阴性率为4.3%(1/23).常规病理检查无转移的29例患者,免疫组化检测发现1例CK-19( )、EMA( ),另1例CK-19( ),CEA( ),而所属非前哨淋巴结无肿瘤转移. 结论乳腺癌亚甲蓝前哨淋巴结定位、活检可以预示腋窝淋巴结转移.     

男性乳腺癌前哨淋巴结活检11例分析

目的 以亚甲蓝注射液为示踪剂检测男性乳腺癌前哨淋巴结,并根据活检及腋窝淋巴结清扫结果评价前哨淋巴结活检在男性乳腺癌治疗中的应用价值.方法 将郑州大学第一附属医院乳腺外科2010年3月-2014年12月收治的男性乳腺癌患者11例入组,临床分期为cT1 ～ T2N0M0.使用亚甲蓝注射液为示踪剂,给予11例患者前哨淋巴结活检,同时给予腋窝淋巴结清扫.结果 11例男性乳腺癌患者,10例检出前哨淋巴结,检出率为90.9％(10/11).前哨淋巴结1～3枚,平均1.8枚.非前哨淋巴结8～14枚,平均10.5枚.1例未检出患者排除分析.10例前哨淋巴结活检成功的患者中6例转移(6/10);前哨淋巴结未转移而非前哨淋巴结转移的患者1例(1/10).本组研究中前哨淋巴结对腋窝淋巴结状况的符合率(准确性)为90％(9/10);灵敏度为100％(6/6)％;准确率为60％(6/10).结论 使用亚甲蓝注射液行前哨淋巴结活检能够准确预测男性乳腺癌腋窝淋巴结的转移情况,可作为早期男性乳腺癌评估腋窝分期的可靠手段.     

吲哚菁绿荧光法在乳腺癌前哨淋巴结活检中的应用

目的评价吲哚菁绿荧光(ICG)法在乳腺癌患者前哨淋巴结活检(SLNB)中的应用价值。方法对2014年2月至2015年3月期间在我院住院且行SLNB的66例乳腺癌患者的临床资料进行回顾性分析,66例患者分别应用ICG法(ICG组,34例)和美蓝染色法(美蓝组,32例)来预测腋窝淋巴结转移情况,对此进行比较。结果所有66例患者中检出前哨淋巴结患者共59例,检出率为89.39%(59/66)。59例检出前哨淋巴结患者中共检出前哨淋巴结162枚,平均2.75枚/例。检出时间为(5.05±1.52)min。在ICG组前哨淋巴结检出率为97.06%(33/34),美蓝组前哨淋巴结检出率为81.25%(26/32),ICG组的前哨淋巴结检出率明显高于美蓝组(P0.05)。59例检出前哨淋巴结中有32例是前哨淋巴结阳性,其中ICG组20例,美蓝组12例。所有患者均行ALND,有35例发现腋窝淋巴结转移,其中ICG组21例,美蓝组14例。ICG组和美蓝组的灵敏度和假阴性率比较差异无统计学意义(95.2%比85.7%,P0.05;4.8%比14.3%,P0.05)。结论 ICG法在乳腺癌患者SLNB的应用中的检出率明显高于美蓝组,且具有操作简单、灵敏度高的特点。     

腔镜下乳腺癌前哨淋巴结活检临床应用及效果分析

目的探讨在腔镜下进行乳腺癌前哨淋巴结活检(SLNB)的可行性及手术效果。方法分析笔者所在医院2009年1月至2012年3月期间行乳腺癌SLNB病例,其中腔镜下活检107例,开放活检303例,采用放射性核素+亚甲蓝联合法与单用亚甲蓝法进行前哨淋巴结(SLN)探测。结果开放组SLN检出率联合法为94.56%(139/147),亚甲蓝法为88.46%(138/156);腔镜组联合法为94.25%(82/87),亚甲蓝法为85.00%(17/20)。检出前哨淋巴结数量,开放组联合法平均1.90枚/例,亚甲蓝法平均1.98枚/例;腔镜组则分别为1.91枚/例和1.82枚/例。SLN阳性率联合法及亚甲蓝法开放组分别为22.30%(31/139)和25.36%(35/138);腔镜组分别为19.51%(16/82)和23.53%(4/17)。上述各指标2组间的差异均无统计学意义(P>0.05)。术后并发症:腔镜组发生皮下积液的比例(5/107)高于开放组(0/303),P=0.001;其他并发症发生情况2组间比较差异均无统计学意义(P>0.05)。结论腔镜下SLNB与传统SLNB可达到相似的安全性与临床效果,但前者表现出较优越的美容效果,腔镜下SLNB可作为乳腺癌SLNB手术技术进行推广应用。     

吲哚氰绿荧光显影联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检中的效果对比

目的探讨吲哚氰绿(ICG)联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检(SLNB)中的效果差异。方法回顾性收集2017年6月到2019年2月期间于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗后行SLNB并同时行腋窝淋巴结清扫(ALND)的乳腺癌患者77例,其中通过ICG+亚甲蓝示踪行SLNB的乳腺癌患者46例(ICG+亚甲蓝组),通过核素+亚甲蓝示踪行SLNB的乳腺癌患者31例(核素+亚甲蓝组)。比较2组患者的示踪效果。结果 77例患者中至少检出1枚前哨淋巴结(SLN)者73例,SLN检出率为94.80%,其中ICG+亚甲蓝组43例,核素+亚甲蓝组30例。ICG+亚甲蓝组患者的NAC后前哨淋巴结检出率为93.48%(43/46),平均检出SLN 2.32枚/例,灵敏度为82.61%(19/23),假阴性率为17.39%(4/23),准确率为90.70%(39/43)。核素+亚甲蓝组的SLN检出率为96.77%(30/31),平均检出SLN 2.6枚/例,灵敏度为83.33%(10/12),假阴性率为16.67%(2/12),准确率为93.33%(28/30)。2组的SLN检出率、检出数目、灵敏度、假阴性率及准确率比较差异均无统计学意义(P0.05)。结论 ICG联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后的乳腺癌SLNB中具有相似的SLN检出率、SLN检出数目、灵敏度、准确率及假阴性率,可以推广实施。     

CEUS联合染料法在乳腺癌前哨淋巴结活检术中的应用

目的探讨CEUS联合染料法在乳腺癌前哨淋巴结活检术(SLNB)中的应用价值。方法将110例女性乳腺癌患者随机分为两组:试验组,57例接受CEUS联合染料法活检前哨淋巴结(SLN);对照组,53例接受染料法联合核素法活检SLN。两组患者均接受腋窝淋巴结清扫术(ALND)及乳腺癌根治术。依据病理结果计算并比较两种方法对SLN的检出能力。结果试验组SLN检出率[91.23%(52/57)]及每例患者SLN平均数量[(1.58±0.89)个]与对照组[100%(53/53),(1.94±0.77)个]比较,差异有统计学意义(P均0.05)。两组敏感度、准确率、阴性预测值的差异均无统计学意义[试验组:81.82%(18/22)、92.31%(48/52)、88.24%(30/34);对照组:71.43%(15/21)、88.68%(47/53)、84.21%(32/38);P均0.05];特异度及阳性预测值均为100%(30/30,32/32)。结论 CEUS联合染料法用于乳腺癌SLN活检具有一定价值。     

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。     

乳腺癌前哨淋巴结解剖学定位的临床研究

目的:探讨示踪剂注射部位对乳腺癌前哨淋巴结(sentinel lymph node,SLN)定位的影响。方法:对53例cN0期乳腺癌患者行核素示踪联合染料染色示踪法检测SLN,在原发肿瘤表面的皮下组织内或切除活组织检查残腔肿瘤周围两点注射99m锝(99mTc)标记的硫胶体,将卡纳琳或亚甲蓝分别注射于肿瘤对角线相应部位的皮下组织内(30例)或乳头乳晕下皮下组织内(23例)。SLN活组织检查后再行腋窝淋巴结清除术,标本行常规HE染色组织学检查。结果:53例患者均成功检测出SLN,核素示踪法与蓝染料法的成功率均为96.23%(51/53),联合检测的成功率100%(53/53),共检出SLN103枚,平均每例检出1.94枚,其中50例SLN位于胸大肌外侧缘的外侧组淋巴结(LevelⅠ),1例位于胸小肌后(LevelⅡ),1例同时位于LevelⅠ及LevelⅡ,1例同时位于LevelⅠ及胸骨旁。全部病例蓝染料与核素示踪标识的SLN均为同一枚(或同一组)淋巴结,两者完全吻合;且蓝染料注射于乳头乳晕或肿瘤对角线部位与核素注射于肿瘤周围所标识的SLN也完全一致。结论:SLN可能是乳房整个器官的SLN,而非乳房某个具体部位的SLN,与示踪剂的注射部位无关。     

Axilloscopy and endoscopic sentinel node detection in breast cancer patients

Background: Sentinel node biopsy is a promising technique that allows the axillary status of breast cancer patients to be predicted with high accuracy. Reducing false negative results remains a major challenge for the improvement of this procedure. Furthermore, new techniques are required to achieve axillary clearing with less morbidity in cases of unsuccessful mapping or multicentric carcinoma. We analyzed whether axilloscopy and endoscopic sentinel node biopsy is a feasible procedure for visualization of the axillary space and resection of the sentinel node using endoscopic techniques. Methods: Following blue dye–guided lymphography and liposuction of the axillary fat, endoscopic axillary sentinel node biopsy was performed in 35 breast cancer patients. We then assessed the exposure of anatomical landmarks, the detection rate of the sentinel node, the false negative rate, and the accuracy of consecutive axillary clearing. Results: In almost every case, an excellent anatomical orientation was achieved. The detection rate for the sentinel node was 83.3%. In one case, the sentinel node did not reflect the status of the residual axilla. A mean number of 17.1 lymph nodes was harvested at consecutive axillary clearing. Conclusions: Axilloscopy and endoscopic sentinel node biopsy, following liposuction of the axillary fat, is a feasible procedure that allows identification and minimally invasive resection of the sentinel node with high accuracy. The endoscopic approach might help to minimize the pitfalls of sentinel node biopsy by visualizing the axillary space. In future, it may become a technique that enables minimally invasive axillary clearing when complete lymphadenectomy is required. Received: 7 April 1999/Accepted: 16 December 1999/Online publication: 17 April 2000     

早期乳腺癌前哨淋巴结活检手术中示踪方法的临床应用研究

目的对比分析核素联合亚甲蓝与亚甲蓝单示踪法在早期乳腺癌前哨淋巴结活检术中应用效果。方法收集我院385例行前哨淋巴结活检术的乳腺癌患者的临床资料,其中109例由高年资医生应用亚甲蓝单示踪法,276例由高年资和低年资两组医生应用核素联合亚甲蓝示踪法,对比分析行联合示踪法与单示踪法前哨淋巴结活检结果的差异。并分析不同年资手术医生在联合示踪法前哨淋巴结活检结果的差异。结果联合示踪法与亚甲蓝单示踪法在前哨淋巴结活检的检出率、假阴性率、准确率、灵敏率无统计学意义(P>0.05),在联合示踪法下,高年资手术医生与低年资手术医生的前哨淋巴结活检的检出率、假阴性率、准确率无显著差异(P>0.05)。结论高年资外科医生使用亚甲蓝单示踪法行前哨淋巴结活检,是安全可靠又经济的方法。联合示踪法有助于帮助年轻的乳腺外科医生快速掌握熟悉前哨淋巴结活检技术。     

早期乳腺癌前哨淋巴结活检手术中示踪方法的临床应用研究

目的对比分析核素联合亚甲蓝与亚甲蓝单示踪法在早期乳腺癌前哨淋巴结活检术中应用效果。方法收集我院385例行前哨淋巴结活检术的乳腺癌患者的临床资料,其中109例由高年资医生应用亚甲蓝单示踪法,276例由高年资和低年资两组医生应用核素联合亚甲蓝示踪法,对比分析行联合示踪法与单示踪法前哨淋巴结活检结果的差异。并分析不同年资手术医生在联合示踪法前哨淋巴结活检结果的差异。结果联合示踪法与亚甲蓝单示踪法在前哨淋巴结活检的检出率、假阴性率、准确率、灵敏率无统计学意义(P>0.05),在联合示踪法下,高年资手术医生与低年资手术医生的前哨淋巴结活检的检出率、假阴性率、准确率无显著差异(P>0.05)。结论高年资外科医生使用亚甲蓝单示踪法行前哨淋巴结活检,是安全可靠又经济的方法。联合示踪法有助于帮助年轻的乳腺外科医生快速掌握熟悉前哨淋巴结活检技术。     

Sentinel node imaging and biopsy in breast cancer patients.

BACKGROUND: Several techniques have been shown to be accurate in identifying axillary sentinel lymph nodes. The accuracy of subareolar blue dye injection is compared with intraparenchymal radioisotope injection. METHODS: Forty-two consecutive patients with breast cancer were injected with both intraparenchymal technetium-99m and subareolar isosulfan blue dye. After sentinel lymph node identification, an axillary lymph node dissection was performed. RESULTS: The blue dye and the technetium-99m localized to the same axillary nodes even though the injection sites were different. The sensitivity of blue dye in identifying axillary sentinel nodes was 100%. The sensitivity of radioisotope injection in identifying sentinel nodes was 97.6%. CONCLUSIONS: Subareolar blue dye injection is an extremely accurate and cost-effective method of sentinel node identification in breast cancer patients.     

不同体积的亚甲蓝检测I期乳腺癌前哨淋巴结的对比研究

【摘要】〓目的〓探讨不同体积的亚甲蓝注射液染色示踪法在I期乳腺癌前哨淋巴结活检中的临床应用价值。方法〓回顾性分析自2010年1月至2015年6月,76例I期乳腺癌病人,分低剂量组(0.2 mL),中剂量组(2 mL),高剂量组(4 mL)3组,使用1%亚甲蓝注射液为示踪剂,行术中前哨淋巴结活检术。结果〓76例患者,成功施行75例前哨淋巴结活检术,检出率为98.7%,准确率为100%,阴性率为0。低剂量组并发症的发生率与另两组存在差异,其差异具有统计学意义。结论〓低剂量0.2 mL亚甲蓝示踪法在I期乳腺癌前哨淋巴结中,准确性高,并发症少。     

Single institution's initial experience with sentinel lymph node biopsy in breast cancer patients

Background: The sentinel lymph node is the first draining node from a cancer‐bearing area and is therefore the first to manifest metastasis. In breast cancer it has been shown to predict the axillary status. Axillary dissection provides information determining prognosis and need for adjuvant therapy but carries a certain morbidity. Our aim was to determine the feasibility of detecting the sentinel node in a teaching hospital and whether the sentinel node accurately predicts the axillary status. Methods: All patients with stage I and II breast cancer and non‐palpable axillary nodes were eligible, including those with previous excision biopsy. We excluded pregnant women, those with previous axillary surgery and women with advanced breast cancer with enlarged axillary nodes. The sentinel node was detected with technetium‐99m‐labelled tin colloid and vital blue dye and removed, and axillary clearance was performed. Results: A total of 312 patients were examined from August 1996 to December 1998. The mean age was 53 years (range 28?83) and mean tumour size 2.6 cm (range 0.2?9.0). The detection rate of the sentinel node was 86%. The sentinel lymph node predicted the axillary status with a sensitivity of 83% and specificity of 100%. The false‐negative rate was 16.7%. Conclusions: Detection of the sentinel lymph node is feasible and it can accurately predict the nodal status of the axilla. ­However, the high false‐negative rate precludes as yet the use of sentinel lymph node biopsy in replacing axillary clearance as the standard of care for breast cancer.     

Blue Dye Injection in the Arm in Order to Conserve the Lymphatic Drainage of the Arm in Breast Cancer Patients Requiring an Axillary Dissection

Background Despite the widespread use of the sentinel lymph node biopsy technique, many patients with invasive breast cancer still undergo an axillary lymph node dissection and are at risk of arm lymphedema. With the new awareness of lymphatic spread in the axillary nodes, it should be possible to define a new surgical approach between sentinel lymph node biopsy and complete axillary dissection, a procedure preserving specifically lymph nodes in relation to the arm. Methods Twenty-one patients with an operable breast cancer requiring an axillary dissection underwent surgery with an attempt to separate nodes related to the breast from specific nodes related to the arm. After an injection of blue dye in the arm, the surgeon performed the axillary dissection trying to identify blue nodes and ducts in order to preserve lymphatic arm drainage (LAD). If the blue nodes were located in the normal axillary dissection, they were removed separately. Results In 15 of 21 patients (71%), blue nodes in relation with LAD were identified. In 10 (47%) patients, it was possible to dissect the LAD with the preservation lymphatic ducts. In 10 patients, the LAD nodes were removed: none of them contained metastases, despite the fact that the non-LAD axillary nodes contained metastases in 7 of 10 cases. Conclusions Identifying the LAD with blue dye injection in the arm is possible. A subsequent study can now begin to determine if this procedure is safe for patients and able to prevent lymphedema of the arm.