乳腺癌前哨淋巴结活检

18 94年 ,美国医生Halsted首创了乳腺癌根治术 ,使术后复发率由当时的 5 8%～ 85 %下降到 6% ,开创了肿瘤器官整块广泛切除和区域淋巴结清扫的经典肿瘤外科治疗原则。 2 0世纪 70年代 ,美国学者Fisher提出乳腺癌是一种全身性疾病 ,区域淋巴结并非癌细胞滤过的有效屏障 ,血流扩散更具重要意义的理论后 ,乳腺癌手术逐步向保乳手术迅速发展。近年来 ,不少学者对乳腺癌常规行腋淋巴结清扫 (axillarylymphnodedissection ,ALND)这一金标准的必要性提出质疑 ,引发了乳腺癌外科治疗的又一次革命[1] 。近期不断有资料显示 ,较小范围的腋淋巴结切…     

前哨淋巴结活检和乳腺癌

前哨淋巴结活检目前正成为乳腺癌外科治疗的研究热点，本文将对其最新的发展进行综述。     

乳腺癌前哨淋巴结活检的研究进展

目的 报道乳腺癌前哨淋巴结活检的研究进展。方法 采用文献回顾的方法，对国外乳腺癌前哨淋巴结活检的历史、概念、活检技术以及临床应用等问题进行综述。结果 乳腺癌前哨淋巴结活检的操作方法还没有统一的标准，检出率及假阴性率变化范围广。结论 前哨淋巴结活检的临床应用还需要大量前瞻性多中心随机实验结果进一步论证。     

乳腺癌前哨淋巴结的定位与活检

目的 探讨乳腺癌前哨淋巴结定位与活检技术的可行性和前哨淋巴结能否准确预告腋淋巴结状况。方法 应用美蓝对32例乳腺癌患者进行术中及术后前哨淋巴结定位与活检。结果 26例（81.25%)检出前哨淋巴结，且均集中在levelⅠ区域，用美蓝定位前哨淋巴结预告腋淋巴结转移的敏感性为77.78%(7/9)。准确性为80.77%(21/26)。特异性为82.35%(14/17)，假阴性率为22.22%(2/9)。结论 前哨淋巴结虽能预测腋淋巴结状态，但要取代腋淋巴结清扫还需进一步研究。     

乳腺癌前哨淋巴结活检手术经验总结

【摘要】目的总结早期乳腺癌前哨淋巴结活检的手术经验。方法回顾性分析2012年1月至2016年6月在我院乳腺外科行乳腺癌腋窝前哨淋巴结活检手术的78例早期乳腺癌病人的临床资料。结果中位年龄54岁（范围32~75岁）,其中48例（62%）患者为右乳癌,30例（38%）为左乳癌。同时,46例（59%）患者肿物位于外上象限,13例（17%）肿物位于外下象限,11例（14%）位于内上象限,8例（10%）位于内下象限。55例（70%）患者为浸润性导管癌（IDC）,16例（21%）为导管原位癌（DCIS）,5例（6%）为浸润性小叶癌（ILC）,2例（3%）为其他类型浸润性癌。前哨淋巴结检出率为90%（70/78）,其中前哨淋巴结阳性率为34%（24/70）,前哨淋巴结阴性率为66%（46/70）。前哨淋巴结准确率为93%（65/70）,假阴性率为11%（5/46）。中位随访时间为12个月,腋窝淋巴结复发1例,余均未见复发事件。结论当前结果符合文献报道,早期乳腺癌腋窝淋巴结活检是一种安全的肿瘤腋窝淋巴结状态评估手段,但需要一定经验的外科医生实施。     

乳腺癌前哨淋巴结活检进展

前哨淋巴结(sentinel lymph node,SLN)是指区域淋巴引流最先到达的淋巴结。据其定义,肿瘤学阴性的SLN意味着该区域淋巴结无肿瘤转移。这样就可对一个SLN阴性的乳腺癌病人免行腋下淋巴结清扫(axillary lymph node dissection,ALND),从而避免ALND带来的不良后果,如患侧上肢麻木、疼痛、水肿、腋下积液和感染,还可缩短住院天数．节省医疗费用,为是否采用辅助治疗提供更准确的指导．     

早期乳腺癌前哨淋巴结活检74例临床分析

目的分析早期乳腺癌前哨淋巴结活检术(SLNB)的临床价值。方法选取患侧SLNB的74例早期乳腺癌患者。观察组38例,SLNB阴性行单纯乳房切除术;对照组36例,SLNB阳性行乳腺癌改良根治术。术后随访6个月,比较2组患者的免疫功能、并发症及患侧肩关节功能。结果观察组患者的免疫功能、术后并发症及患侧肩关节功能均优于对照组,差异有统计学意义(P0.05)。结论对SLNB阴性的早期乳腺癌患者实施单纯乳房切除术,操作简便、创伤较小、并发症少,有利于维护患侧肩关节功能和机体免疫功能。     

乳腺癌前哨淋巴结活检研究进展

在乳腺癌的外科治疗中，不论是改良根治还是保留乳房治疗，都要常规进行腋窝淋巴结清扫，以获得肿瘤分期资料从而指导下一步治疗，但腋窝淋巴结清扫会带来许多并发症，如上肢水肿和功能障碍、皮下积液、刀口愈合不良等，为了避免这些并发症，又能进行准确的分期，前哨淋巴结(setinel lymph node，SLN)活检技术应运而生，它具有操作简     

前哨淋巴结活检在早期乳腺癌治疗中的临床价值

目的探讨前哨淋巴结活检(SLNB)术在早期乳腺癌治疗中的临床价值。方法选取2014-09—2016-08间收治的78例乳腺癌患者,根据术式不同分为2组。均先实施患侧腋窝SLNB清扫切除、快速冰冻病理学检查。观察组(35例)病理检查结果示SLNB阴性,随给予单纯乳房切除术。对照组(43例)病理检查结果示SLNB阳性,行保留胸大、小肌的乳腺癌改良根治术。术后随访6个月,比较2组患者患侧上肢的功能。结果末次随访,2组患者患侧上肢的麻木、疼痛感比较,差异无统计学意义(P0.05);但观察组患者患侧上肢水肿及肩关节活动障碍的发生率均显著低于对照组,差异有统计学意义(P0.05)。结论对SLNB病理检查阴性的早期乳腺癌患者实施单纯乳房切除和SLNB清扫切除术,操作简便、创伤较小、并发症少,而且对患侧肩关节功能影响较小。     

Sentinel node biopsy performed before preoperative chemotherapy for axillary lymph node staging in breast cancer

Sentinel node (SN) biopsy in breast cancer patients following preoperative chemotherapy is associated with a decreased identification rate and an increased false-negative rate when compared to SN biopsy performed in untreated patients. We performed SN biopsy in 21 breast cancer patients scheduled for preoperative chemotherapy using either vital blue dye alone (n = 11) or in combination with a radiocolloid (n = 10). Following a mean of four cycles of preoperative chemotherapy, surgery to the breast and complete axillary lymph node dissection was performed irrespective of the SN status. A mean of 1.9 SNs were identified in all 21 patients, 12 were SN negative and 9 were SN positive. Preoperative chemotherapy decreased mean tumor size from 40.2 to 17.7 mm and breast conservation was possible in 14 of 21 patients (67%). All SN-negative patients and three of nine SN-positive patients had negative lymph nodes in the axillary specimen, whereas six of nine patients with a positive SN revealed lymph node metastases following preoperative chemotherapy. SN biopsy performed before preoperative chemotherapy found a 100% identification rate with no false-negative results. Following preoperative chemotherapy, SN-negative patients may forego a complete axillary dissection.     

Sentinel lymph node biopsy after neo-adjuvant chemotherapy in breast cancer

The timing of sentinel node biopsy in the setting of neo-adjuvant chemotherapy for breast cancer is controversial. Sentinel node biopsy performed after neo-adjuvant chemotherapy may save patients with a nodal response the morbidity of an axillary lymph node dissection. A retrospective review of prospectively collected data compared sentinel node biopsies performed after patients had received neo-adjuvant chemotherapy with patients who had not received neo-adjuvant chemotherapy. Demographic factors, tumor characteristics, and the results of the sentinel node biopsies and completion lymph node dissections (when applicable) were compared. A total of 231 axillary procedures (224 patients) were evaluated. The patients who received neo-adjuvant chemotherapy (NEO; N=52) were younger, had higher grade tumors, were more likely to have a mastectomy, and were more likely to have ER-negative and HER-2/neu positive tumors than the patients who did not receive neo-adjuvant chemotherapy (NON; N=179). The mean clinical tumor size in the neo-adjuvant group was 4.5cm (±1.8) prior to chemotherapy; the post-chemotherapy pathologic size was 1.4cm (±1.3). A sentinel node was identified in all cases. There were no significant differences between the groups in the mean number of sentinel nodes removed (NEO=3.3; NON=3.1; p=0.545), the percentage of positive axillae (NEO=24%; NON=21%; p=0.776) or the mean number of positive sentinel nodes (NEO=1.3; NON=1.5; p=0.627). There was no difference in the percentage of completion lymph node dissections with additional positive nodes (NEO=20%; NON=35%; p=0.462); there was a difference in the number of nodes removed in the completion lymph node dissections (mean NEO=12.0; NON=16.4; p=0.047). Sentinel node biopsy performed after neo-adjuvant chemotherapy appears to be an oncologically sound procedure and may save some patients the morbidity of a complete lymph node dissection.     

Sentinel lymph node biopsy for breast cancer: improvement in results over time

Many modifications in the technique of sentinel lymph node (SLN) biopsy for breast cancer have taken place since it was first introduced. This analysis was undertaken to determine, in a large multi-institutional study, whether SLN biopsy results have improved over time. Patients with clinical stage T1-2, N0 breast cancer were enrolled in this prospective study between August 1997 and February 2002. SLN biopsy was performed using blue dye and/or radioactive colloid along with completion level I/II axillary dissection in all patients. The majority of subjects included in this study represent the surgeons' initial experience with SLN biopsy for breast cancer. Statistical comparison of the SLN identification (ID) rate and false-negative (FN) rate were performed by chi-squared analysis. A total of 3370 subjects from 300 surgeons were enrolled in the study. Collectively the SLN ID rate, as well as the mean number of SLNs removed per patient has improved, while the FN rate has remained fairly constant over time. The improved ID rate may be related to improved technical details, while the FN rate has not changed significantly. This highlights the ongoing need for surgeons to perform backup axillary dissection during their initial learning phase.     

乳腺癌前哨淋巴结活检的临床应用研究

目的探讨乳腺癌前哨淋巴结活检术（SLNB）在临床应用中的价值。方法应用亚甲蓝染色法对58例乳腺癌患者先行SLNB,随后行乳腺癌常规外科手术。结果58例患者中前哨淋巴结（SLN）检出率为93．1％,准确率为96．3％。假阴性率为5．71％,假阳性率为0;操作者的学习曲线、患者的年龄、原发肿瘤的部位影响SLN的检出率（P〈0．05）;肿瘤的大小、病理类型不影响SLN的检出率（P〉0．05）。结论乳腺癌SLNB能够准确地预测乳腺癌患者腋窝淋巴结（ALN）的转移情况。     

Sentinel node biopsy for breast cancer: using local results for estimation of risk to the patient

Background: Sentinel node biopsy (SNB) is being increasingly used but its place outside randomized trials has not yet been established. Methods: The first 114 sentinel node (SN) biopsies performed for breast cancer at the Princess Alexandra Hospital from March 1999 to June 2001 are presented. In 111 cases axillary dissection was also performed, allowing the accuracy of the technique to be assessed. A standard combination of preoperative lymphoscintigraphy, intraoperative gamma probe and injection of blue dye was used in most cases. Results are discussed in relation to the risk and potential consequences of understaging. Results: Where both probe and dye were used, the SN was identified in 90% of patients. A significant number of patients were treated in two stages and the technique was no less effective in patients who had SNB performed at a second operation after the primary tumour had already been removed. The interval from radioisotope injection to operation was very wide (between 2 and 22 h) and did not affect the outcome. Nodal metastases were present in 42 patients in whom an SN was found, and in 40 of these the SN was positive, giving a false negative rate of 4.8% (2/42), with the overall percentage of patients understaged being 2%. For this particular group as a whole, the increased risk of death due to systemic therapy being withheld as a consequence of understaging (if SNB alone had been employed) is estimated at less than 1/500. The risk for individuals will vary depending on other features of the particular primary tumour. Conclusion: For patients who elect to have the axilla staged using SNB alone, the risk and consequences of understaging need to be discussed. These risks can be estimated by allowing for the specific surgeon's false negative rate for the technique, and considering the likelihood of nodal metastases for a given tumour. There appears to be no disadvantage with performing SNB at a second operation after the primary tumour has already been removed. Clearly, for a large number of patients, SNB alone will be safe, but ideally participation in randomized trials should continue to be encouraged.     

Sentinel node biopsy in breast cancer and melanoma requires adequate self-audit

BACKGROUND: Sentinel node biopsy (SNB) is an evolving technique with potential for improving staging. Melanoma and breast cancer are the two most commonly used applications. The present study relates the author's validation data in both diseases. METHODS: Review of a prospective database. RESULTS: Between January 2000 and December 2001 92 cases of breast cancer were offered SNB. The first 48 had completion axillary dissection. The identification rate was 92%. There were 28 true negative, 15 true positive and one false negative case. A mean of 2.0 nodes were removed (range 1-4). Completion axillary dissection removed a mean of 15.1 nodes. The following 44 cases were offered a choice of SNB alone, axillary dissection or a combination of techniques. Thirty-seven women chose SNB alone. There was one technical failure, 28 negative SNB and eight positive SNB results. A mean of 3.1 lymph nodes were removed (range 1-9) applying a 10% rule. At 24-36 months follow up there have been no cases of locoregional recurrence. From January to December 2001 36 cases of melanoma > or =1 mm were managed with SNB. Twenty-eight SNB were negative and eight were positive (22%). At follow up (range 12-24 months) there were three locoregional recurrences, but only one of these were in the node basin determined to be previously negative by SNB (3.5%). DISCUSSION: Sentinel node biopsy in breast cancer is a valid alternative to full axillary dissection for staging the axilla. Patients can make an informed choice to have SNB alone if they understand the limitations of the technique and possible consequences of these limitations. In melanoma SNB provides valuable prognostic information most melanoma patients prefer to have. Adequate self-audit is necessary before a patient can make an informed decision to have SNB in either disease.     

胃癌前哨淋巴结研究进展

前哨淋巴结是从原发肿瘤淋巴引流途中首先可能发生转移的部位。Cabana在阴茎癌中提出前哨淋巴结的概念后,前哨淋巴结活检技术不断在多种肿瘤中广泛应用。目前,该技术已成功用于黑色素瘤、乳腺癌等手术。但在胃癌中,由于胃淋巴引流复杂、存在跳跃转移以及假阴性率较高,前哨淋巴结活检技术应用于临床还为时过早,其可行性和适用性尚无定论。因此,前哨淋巴结活检技术应用于胃癌,还有许多问题需要回答。     

前哨淋巴结活检在乳腺癌中的临床应用

目的 探讨术中前哨淋巴结（sentinel lymph node,SLN）定位和活检（SLNB）对预测乳腺癌腋窝淋巴结（axillary lymph node,ALN）转移的准确性.方法 对48例乳腺癌患者术前10min用亚甲蓝注射液4ml注射到肿瘤周围或活检腔的正常乳腺组织,进行SLN定位和活检,然后行乳腺癌改良根治术.结果 SLNB的检出成功率为95.8%,准确率为97.8%,假阴性率3.0%,假阳性率为0.结论 用亚甲蓝作SLN定位进行SLNB能准确预测乳腺癌ALN转移状态.     

淋巴闪烁显像与乳腺癌前哨淋巴结活检

乳腺癌前哨淋巴结的精确定位是乳腺癌前哨淋巴结活检成功的先决条件之一,明确乳腺淋巴引流途径对乳腺癌前哨淋巴结的准确定位有重要指导意义。术前淋巴闪烁显像可提供个体化的淋巴引流特点,有助于确定前哨淋巴结的位置、数目及是否存在腋窝外前哨淋巴结。现对淋巴闪烁显像在乳腺癌前哨淋巴结活检中的应用现状和存在的问题进行综述。