乳腺癌染料法前哨淋巴结活检的临床意义

前哨淋巴结活检 (ｓｅｎｔｉｎｅｌｌｙｍｐｈｎｏｄｅｂｉｏｐｓｙ,ＳＬＮＢ)技术的临床应用 ,有可能改变乳腺癌外科治疗中常规行腋窝淋巴结解剖 (ａｘｉｌｌａｒｙｌｙｍｐｈｎｏｄｅｓｄｉｓｓｅｃｔｉｏｎ ,ＡＬＮＤ)这一历史[1] 。我科自 2 0 0 0年 7月以来 ,采用 1%异硫蓝 (1%ｉｓｏｓｕｌｆａｎｂｌｕｅ)对5 2例乳腺癌患者开展了ＳＬＮＢ ,现将结果报告如下 ,并就其临床价值进行初步探讨。一、资料与方法1 一般资料 :本组 5 2例均为女性。年龄 38～ 74岁 ,平均 5 1.3岁。Ｔ134例 ,Ｔ2 18例 ,腋淋巴结扪诊均未见肿大。全组行乳腺癌改…     

早期乳腺癌染料法前哨淋巴结活检的研究进展

全文从前哨淋巴结活检的历史出发,论述国内外有关染料法行早期乳腺癌前哨淋巴结活检的研究现状。     

早期宫颈癌前哨淋巴结检测的临床应用进展

[指示性]广泛全子宫切除加双侧盆腔淋巴清扫术是早期宫颈癌的规范手术模式,大部分早期宫颈癌患者虽然没有盆腔淋巴转移却实施了盆腔淋巴清扫术,造成过度治疗和不必要的损伤。如何预测早期宫颈癌的盆腔淋巴结受累状况,据此来决定手术方式,减少并发症是早期宫颈癌手术治疗中研究的重点。本文就早期子宫颈癌前哨淋巴结检测的临床应用研究进展做一简要综述。     

前哨淋巴结活检在乳腺癌中的临床应用

目的 :通过术中鉴别乳腺癌前哨淋巴结 ,以证实乳腺癌在淋巴管播散呈序贯性的假说。方法 :本组 4 5例乳腺癌患者 ,术前 10min用美蓝液 4ml注射到肿瘤周围 ,然后行乳腺癌改良根治术 ,或乳腺区段切除加腋窝淋巴清除术。在切除标本中 ,从原发肿瘤周围先解剖出染色淋巴管 ,然后追寻到第一站引流淋巴结 (前哨淋巴结 )。结果 :在 4 5例乳腺癌患者中成功活检出前哨淋巴结 31例 ,成功率 6 9%。活检出前哨淋巴结平均每例 1.2枚 (0～ 3枚 ) ,清除腋窝淋巴结平均每例 11枚 (范围 6～ 2 3枚 )。 71%病例其前哨淋巴结与腋窝淋巴结性质相符 ,2 9%病例仅为前哨淋巴结阳性。无 1例发生淋巴结跳跃性转移。结论 :①用美蓝染色方法 ,可以活检出前哨淋巴结 ,但其检出率不太理想。有必要与核素扫描等方法结合起来。②本研究证实乳腺癌在淋巴管播散呈序贯性的假说。     

乳腺癌前哨淋巴结活检染料和手术时机选择

目的：通过乳腺淋巴引流动物模型及临床乳腺癌来研究染料法前哨淋巴结活检（SLNB）合适染料和手术时机的选择。方法：以12只雌性成年兔第2对乳腺的淋巴引流模型来观察异硫蓝组，美蓝组和两者联合组淋巴结依次染色的时间，枚数和褪色的时间。在12例乳腺癌患者行SLNB时进行仔细观察。结果：通过动物模型发现，异硫蓝组和联合组淋巴结染色的时间明显短于美蓝组，淋巴结染色的枚数明显多于美蓝组；异硫蓝组褪色的时间明显快于美蓝组和联合组，12例乳腺癌患者中有11例注射异硫蓝后30秒－45秒发现淋巴管开始染色，2分钟内即可发现染色的淋巴结。结论：成年雌性兔是一种较为理想的乳腺淋巴引流模型，可用于SLNB的研究。异硫蓝和美蓝联合使用具有互补性。我们推荐1％异硫蓝行乳腺癌SLNB时间为注射染料后1分钟。     

乳腺癌前哨淋巴结活检常用染料效果实验研究

目的通过动态观察国内外最常使用的3种生物活性染料:1%异硫蓝(isosulfanblue,IB)、1%专利蓝(patentblue,PB)及1%美蓝(methyleneblue,MB)在大耳白家兔第二对乳腺至腋窝淋巴系统的运行特性,为临床选取理想的染料示踪剂行乳腺癌前哨淋巴结活检(sentinellymphnodebiopsy,SLNB)提供实验依据。方法30只雌性大耳白家兔随机分为3组,每组10只。全麻后,首先分离皮瓣,暴露部分第二对乳腺、连接乳腺与腋窝淋巴结之间的淋巴管以及腋窝,向第二对乳腺注射不同染料0.1ml,取染料经淋巴管到达的第一站淋巴结为前哨淋巴结(sentinellymphnode,SLN),观察SLN和第二站淋巴结染色的时间、淋巴结染色枚数以及淋巴结的褪色时间。结果注射后,染料到达腋窝第一站淋巴结的时间以IB组最长,平均为20.6秒;PB组其次,平均16.8秒;MB组最短,平均14.7秒,组间比较差异明显(P=0.040)。腋窝淋巴结染色枚数3组无明显差异(P=0.235)。肉眼观,淋巴结染色以MB组最深,IB组次之,而PB组最浅。第二站淋巴结染色时间IB最长,平均45.8秒,PB为40.6秒,两者比较无差异(P=0.257),MB最短,为23.5秒,与前两者比较差异明显(均为P=0.000)。蓝染淋巴结的褪色时间以PB组最短,6.384±0.944分钟明显褪色,于32.3±3.3分钟完全褪色;IB组次之,33.9±2.8分钟可见明显褪色,于64.2±2.4分钟完全褪色;MB组最长,观察至6小时淋巴结仍呈深染,组间比较差异明显(均为P=0.000)。结论MB到达SLN时间较短,淋巴结染色鲜明且持久,IB和PB在SLN中停留时间较长,染色范围较大便于寻找,3种染料的SLN检出率无差别,3种染料各具优缺点,效果相仿。     

染料法乳腺癌前哨淋巴结活检的临床研究

目的探讨亚甲蓝法乳腺癌前哨淋巴结活检(SLNB)的临床意义,及影响检出率的相关因素.方法选择T1-2N0M0乳腺癌患者124例,取1%亚甲蓝3ml-5ml四点法肿瘤周围注射,先行SLNB,随后行乳腺癌改良根治术.结果124例患者中SLN检出率为86.3%(107/124);准确率为94.4%(101/107);灵敏度为88.5%(46/52);假阴性率为11.5%(6/52);假阳性率为0(0/52).SLN检出率与肿瘤位置、确诊方式有关(P＜0.05),与肿瘤大小、病理类型、雌激素受体(ER)无关(P＞0.05).结论亚甲蓝法SLNB具有安全可靠、经济实用、敏感性和准确性较高等特点,能够较准确地预测腋窝淋巴结(ALN)转移状态.     

染料法乳腺癌前哨淋巴结活检的临床研究

目的：探讨亚甲蓝法乳腺癌前哨淋巴结活检（SLNB）的临床意义，及影响检出率的相关因素。方法：选择T1-2N0N0乳腺癌患者124例，取1％亚甲蓝3ml-5ml四点法肿瘤周围注射，先行SLNB，随后行乳腺癌改良根治术。结果：124例患者中SLN检出率为86．3％（107／124）；准确率为94．4％（101／107）；灵敏度为88．5％（46／52）；假阴性率为11．5％（6／52）；假阳性率为0（0／52）。SLN检出率与肿瘤位置、确诊方式有关（P〈0．05），与肿瘤大小、病理类型、雌激素受体（ER）无关（P〉0．05）。结论：亚甲蓝法SLNB具有安全可靠、经济实用、敏感性和准确性较高等特点，能够较准确地预测腋窝淋巴结（hEN）转移状态。     

前哨淋巴结活检在乳腺癌中的临床应用

目的：通过术中鉴别乳腺癌前哨淋巴结,以证实乳腺癌在淋巴管播散呈序贯性的假说。方法：本组４５例乳腺癌患者,术前１０min用美蓝液４ml注射到肿瘤周围,然后行乳腺癌改良根治术,或乳腺区段切除加淋巴清除术。在切除标本中,从原发肿瘤先解剖出染色淋巴管,然后追寻到第一站引流淋巴结（前哨淋巴结）。结果：在４５例乳腺癌患者中成功活检出前哨淋巴结３１例,成功率６９％。活检出前哨淋巴结平均每例１.2枚（０－３枚）,清除腋窝淋巴结平均每例１１枚（范围６－２３枚）。７１％病例其前哨淋巴结与腋窝淋巴结性质相符,２９％病例仅为前哨淋巴结阳性。无１例发生淋巴结跳跃性转移。结论：（１）用美蓝染色方法,可以活检出前哨淋巴结,但其检出率不太理想,有必要与核素扫描等方法结合起来。（２）本研究斑点实乳腺癌在淋巴管播散呈序贯性的假说。     

乳腺癌前哨淋巴结活检的临床研究

目的:探讨染料法检测乳腺癌前哨淋巴结的意义.方法:在肿瘤周围的3、6、9、12点各注射亚甲蓝稀释液1ml,20分钟后在同侧胸大肌外侧缘至腋窝方向寻找蓝染淋巴管至蓝染淋巴结,检出蓝染淋巴结后单独送病检.然后根据术前制订术式进行手术.结果:36例检出前哨淋巴结34例,成功率94.4%(34/36);前哨淋巴结无癌转移22例中腋淋巴结有癌转移2例,假阴性14.3%(2/14).结论亚甲蓝染料法检测乳腺癌前哨淋巴结价廉易行,有一定意义,但需更多病例证实.     

前哨淋巴结活检术在结直肠癌中的应用研究(英文)

Objective:The aim of this study was to investigate the feasibility of sentinel lymph node biopsy(SLNB) in colorectal cancer.Methods:Twenty patients of colorectal cancer were enrolled in this study.Endoscopic injection submucosally of 99mTc-DX was performed around the primary tumor 3 h before operation.Immediately after laparotomy, methylene blue was injected into subserosal layer adjacent to the tumor.Sentinel lymph nodes(SLNs) were defined as blue stained nodes or(and) those containing 10 times more radioa...     

前哨淋巴结检测术在早期宫颈癌诊疗中的研究进展

宫颈癌是最常见的妇科恶性肿瘤,淋巴结转移状态是影响宫颈癌预后和生存率的重要因素.根据FIGO分期,Ia2期以上的患者常行广泛性子宫切除术和盆腔淋巴结清扫术.早期宫颈癌患者淋巴结转移率低,而盆腔淋巴结清扫可能会导致许多并发症的出现,严重影响患者的术后生活质量.前哨淋巴结(senti-nel lymph node,SLN)...     

Comparisons of ICG-fluorescence with conventional tracers in sentinel lymph node biopsy for patients with early-stage breast cancer: A meta-analysis

Radioisotopes (RI) and blue dye (BD) are routinely used markers for staining during sentinel lymph node biopsy (SLNB) in breast cancer. Compared with traditional tracers, tracer performance of indocyanine green (ICG) has been controversial. A total of 21 studies were selected from the PubMed, EMBASE and Cochrane Library databases. Detection ability was judged based on four endpoints: i) The identification rate (IR) of the patients; ii) the IR of the sentinel lymph nodes (SLNs); iii) the IR of the positive SLNs; and iv) the false negative rate (FNR). Compared with BD, ICG was superior in terms of the IR of the patients [odds ratio (OR)=7.17; 95% CI, 3.98-12.94), the IR of the SLNs (OR=8.84; 95% CI, 6.71-11.66) and FNR (OR=0.20; 95% CI, 0.08-0.48) using a fixed-effects model. There was a significant difference in both the IR of the positive SLNs (OR=21.32; 95% CI, 2.84-160.14) and FNR (OR=0.46; 95% CI, 0.23-0.91) in the ICG vs. RI group. Furthermore, when using ICG at the recommended dose, a significant difference was found in the IR of the patients (OR=1.77; 95% CI, 1.09-2.85) and the IR of the SLNs (OR=21.62; 95% CI, 5.23-89.43) using a fixed-effects model. In the ICG vs. BD combined with RI group, there were no differences in either the IR of the patients (OR=5.10; 95% CI, 0.24-107.48) or the IR of SLNs (OR=5.10; 95% CI, 0.60-256.66). In conclusion, ICG was a better tracer compared with BD or RI alone and was not a worse tracer compared with BD combined with RI. The use of the recommended dose of ICG had an improved tracer effect. ICG is expected to be widely used in SLNB in view of its clinical advantages.     

乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床研究

目的：探讨乳腺癌在乳腔镜下行前哨淋巴结活检及腋窝淋巴结清扫的可行性。方法：通过亚甲蓝示踪对40例Ⅰ、Ⅱ期乳腺癌行乳腔镜前哨淋巴结活检（ESLNB）,然后行乳腔镜腋窝淋巴结清扫（EALND）,对获得的全部淋巴结行病理检查HE染色,确定前哨淋巴结（SLN）检出率、假阴性率等。结果：40例乳腺癌患者SLN检出率为97.44%（39/40）,准确率为94.87%（37/39）,灵敏度为94.74%（18/19）,假阴性率5.26%（1/19）;每例平均前哨淋巴结活检（SLNB）检出数目1-6枚,腋窝淋巴结清扫（ALND）检出数目10-29枚。结论：应用乳腔镜下前哨淋巴结活检和腋窝淋巴结清扫准确可行,美容效果好,并发症低,可对早期乳腺癌进行准确腋窝淋巴结分期。     

乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床研究

目的:探讨乳腺癌在乳腔镜下行前哨淋巴结活检及腋窝淋巴结清扫的可行性。方法:通过亚甲蓝示踪对40例Ⅰ、Ⅱ期乳腺癌行乳腔镜前哨淋巴结活检(ESLNB),然后行乳腔镜腋窝淋巴结清扫(EALND),对获得的全部淋巴结行病理检查HE染色,确定前哨淋巴结(SLN)检出率、假阴性率等。结果:40例乳腺癌患者SLN检出率为97.44%(39/40),准确率为94.87%(37/39),灵敏度为94.74%(18/19),假阴性率5.26%(1/19);每例平均前哨淋巴结活检(SLNB)检出数目1-6枚,腋窝淋巴结清扫(ALND)检出数目10-29枚。结论:应用乳腔镜下前哨淋巴结活检和腋窝淋巴结清扫准确可行,美容效果好,并发症低,可对早期乳腺癌进行准确腋窝淋巴结分期。     

探测前哨淋巴结在早期宫颈癌中的应用

目的 :评价核素淋巴显像和r探针定位在宫颈癌中确定SLN的应用价值。方法 :2 2例女性宫颈癌病人 ,体检盆腔未扪及肿块。应用99mTc DX 74MBq(2mCi)在宫颈肿瘤周围 2°或 10°处注射 ,行核素淋巴显像后 ,对手术后的标本用γ探针行体外定位 ,并与病理的结果加以对照。结果 :2 2例病人中活检SLN 17例 ,其灵敏度为10 0 % (4/4例 ) ,特异性 10 0 % (13/13例 )。结论 :盆腔前哨淋巴结的病理结果基本能准确反映盆腔淋巴结的病理状态 ,核素定位法在宫颈癌中检测盆腔前哨淋巴结是切实可行和可能的。     

Clear cell sarcoma in the era of sentinel lymph node mapping

Clear cell sarcoma of the tendons and aponeuroses (CCSTA) are rare aggressive soft tissue tumors with tendency for lymph nodes dissemination. Lymph node involvement is a correlate for prognosis. We present three patients with CCSTA in whom simultaneous sentinel lymph biopsy (SLNB) and resection was performed. Sentinel lymph node mapping may have a role in clear cell sarcoma from a prognostic standpoint. Further investigations are needed for validation.     

胃癌前哨淋巴结研究的临床意义

清扫有癌转移的淋巴结是胃癌根治性切除的基本要求。理想的解决方案是找到一种在术前或术中准确判断区域淋巴结转移情况的方法,对不同的病例实施个体化的淋巴结清扫术。术中检测前哨淋巴结对指导胃癌淋巴结的清扫范围有肯定的价值。     

Efficacy of sentinel lymph node biopsy in male breast cancer

BACKGROUND: Sentinel lymph node biopsy (SLNB) is rapidly becoming the standard of care in the treatment of women with early stage breast cancer. Male breast cancer although relatively rare, has typically been treated with mastectomy and axillary lymph node dissection (ALND). Men who develop breast carcinoma have the same risk as their female counterparts of developing the morbidities associated with axillary dissection. SLNB has been championed as a procedure aimed at preventing those morbidities. We recently have evaluated the role of SLNB in the treatment of men with early stage breast cancer. METHODS: Among the 18 men treated at the University of Michigan Medical Center for breast cancer from May 1998 to November 2002, 6 were treated with SLNB. RESULTS: The mean tumor size was 1.6 cm. The mean patient age was 59.8 years. All of the patients had one or more sentinel lymph nodes identified. Two of the six did not have confirmatory axillary dissection. Three of the six had positive sentinel lymph nodes (50%). Only one of the three patients with a positive sentinel node had more nodes positive. One of the six patients had a positive node on frozen section and underwent immediate complete axillary dissection. This patient had no additional positive nodes. No patients in our series had immunohistochemical studies of the lymph nodes. CONCLUSIONS: Men with early stage breast carcinoma may be offered the management option of SLNB since in the hands of experienced surgeons it has a success rate apparently equal to that in their female counterparts.     

核素示踪乳腺癌前哨淋巴结活检的准确性与可行性

目的:探讨核素示踪乳腺癌前哨淋巴结(SLN)活检的准确性和可行性。方法:1999年4月-2001年10月期间,应用原发肿瘤周围皮下注射放射性核素示踪技术(99mTC-标记硫化锑胶体或99mTC-标记硫胶体),对79例早期乳腺癌患者进行前哨淋巴结活检(SLND),随后,行包括腋窝淋巴结清扫(ALND)在内的根治性手术。分析评估两种核素淋巴示踪和SLND的准确性及其影响因素。结果:75例行术前淋巴闪烁照相,淋巴结显像67例(89.33%,67/75);术中应用γ探测仪成功证实SLNs 68例,成功率为86.08%(68/79),SLN预测腋窝淋巴结状态的准确性为95.59%(65/68),假阴性率为3/36(8.33%);前28例患者有9例不能证实SLN,3例假阴性;而后51例只有2例不能证实SLN,没有假阴性。两者差异有显著性(P<0.05)。结论:本研究结果表明,99mTC-标记硫胶体作为示踪剂,手术当天(术前4-6小时)乳腺肿瘤上方皮下注药进行SLND,可以准确预测早期乳腺癌腋窝淋巴结状态。