乳腺癌患者手术创面冲洗液细胞学检查的价值

目的　观察乳腺癌患者手术创面脱落癌细胞与临床病理分期的关系 ,为术中采用杀灭脱落癌细胞的措施提供依据。　方法　对 2 6 2例乳腺癌患者手术创面冲洗液进行细胞学检查 ,并将结果与临床病理分期做对比分析。　结果　本组患者脱落癌细胞阳性者 6 3例 ,占 2 4%。Ⅰ、Ⅱ、Ⅲ、Ⅳ期乳腺癌患者脱落癌细胞检出率分别为 5 3%、2 7 1%、79 3%、10 0 %。T1、T2 和T3 以上者 ,脱落癌细胞检出率分别为 6 1%、18 9%、5 1 3%。腋淋巴结转移数目超过 3枚者 ,脱落癌细胞阳性率为5 8 6 % ;而转移数目≤ 3个和无腋淋巴结转移者 ,阳性率分别为 14 3%、14 1%。　结论　乳腺癌患者手术创面脱落癌细胞检出率随着肿瘤增大、病期进展、淋巴结转移数目的增多而增加 ,术中创面采用杀灭脱落癌细胞的措施是必要的。     

乳腺部患者手术创面冲洗液细胞学检查的价值

目的 观察乳腺癌患者手术创面脱落癌细胞与临床病理分期的关系,为术中采用杀来脱落癌细胞的措施提供依据。方法 对２６２例乳腺癌患者手术创面冲洗液进行细胞学检查,并将结果与临床病理分期做对比分析。结果 本组虱脱落癌细胞阳性者６３例,占２４％。Ⅰ、Ⅱ、Ⅲ、Ⅳ期乳腺癌患者脱落癌细胞检出率分别为５．３％、２７．１％、７９．３％１００％。Ｔ１、Ｔ２和Ｔ３以上者,脱落癌细胞检出纺分别为６．１％、１８．９％、５６１     

176例Ⅱ、Ⅲ期乳腺癌腋淋巴结转移临床病理相关因素分析

目的探讨乳腺癌腋淋巴结转移的临床病理相关因素,为乳腺癌患者病情判断、选择合理手术方式及术后辅助治疗方案提供依据。方法回顾性分析经手术治疗的176例Ⅱ、Ⅲ期乳腺癌患者与腋淋巴结转移相关临床病理资料。结果影响Ⅱ、Ⅲ期乳腺癌腋淋巴结转移及转移数目的重要因素有乳腺癌的病理类型、分期、肿瘤大小、部位以及ER/PR和HER2表达状况。结论乳腺癌腋窝淋巴结转移受多种因素影响。     

金属硫蛋白与乳腺癌预后的关系

为探讨金属硫蛋白与乳腺癌转移和预后的关系,应用免疫组织化学ＳＡＢＣ法检测了乳腺癌及乳腺纤维腺瘤中ＭＴ的表达。结果;ＭＴ在乳腺癌,乳腺纤维腺瘤中的表达阳性率分别为７３．８％和１５．０％,两者的差异有显著性意义。ＭＴ在乳腺癌中的表达随临床分期的升高而增加。ＭＴ在肿瘤中的表达与手术时腋淋巴结转移无相关性,但在腋淋巴结有转移的肿瘤其ＭＴ表达阳性者死亡率高于表达阴性者。     

不同术式对T_1乳腺癌病人的疗效评估

目的：探讨不同术式对Ｔ１乳腺癌的疗效。方法：观察Ｈａｌｓｔｅｄ术、改良根治术和乳房象限切除加腋淋巴结清扫术对２７４例Ｔ１乳腺癌病人预后的影响;并分析全部病人的腋淋巴结转移情况。结果：Ｔ１乳腺癌病人１０年生存率为８４．７％;标准根治术与改良根治术后病人的１０年生存率分别为８０．５石％和８４．１％（Ｐ＞０．０５）;乳房象限切除加腋淋巴结清除术与根治术相比,Ｔ１Ｎ０Ｍ０病人的１０年生存率分别为１００％和９０．４％（Ｐ＞０．０５）;全组腋淋巴结转移率为２７．７％;９７．４％的转移淋巴结位于低位组。结论：３种术式治疗Ｔ１乳腺癌病人的效果相同,从美观及心理因素上考虑,提倡行保守性手术;２／３以上Ｔ１病人无腋淋巴结转移,一律行腋淋巴结清除对预后意义不大,前哨淋巴结活检可以解决这一问题;腋淋巴结转移绝大多数在低位组,在不能进行前哨淋巴结活检的情况下,可仅清除低、中位淋巴结。     

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104例早期诊断分析报告

１９８７年１月至１９９５年１０月，我院收治临床早期乳腺癌１０４例，其中Ｔ０癌８２例，微小癌２２例。全部行手术治疗。病理类型６０例（５７．７％）为早期癌，包括非浸润性癌４５例，早期浸润性癌１５例。腋淋巴结转移为１０．７％，５年生存率为１００％（６５／６５），早期癌的主要临床表现为乳头溢流，乳头糜烂，局限性腺体增厚和直径≤０．５ｃｍ的乳房肿块，多数病例伴有乳腺癌的易患因素，本文强调对早期癌的新概念，必     

腋淋巴结无转移的乳癌患者雌激素受体检测的预后价值

目的 探讨雌激素受体（ＥＲ）状况对腋淋巴结阴性（以下简称ＮＬ）乳腺癌患者预后的影响。方法 对我院１９８５年４月至１９９２年８月手术治疗的１２８例ＮＬ乳腺癌患者和２６６例腋窝淋巴结转移的乳腺癌患者,用免疫组织化学法检测其标本的ＥＲ状况,并对患者进行随访。结果 １２８例ＮＬ乳腺癌ＥＲ检测阳性率７１．１％,同期腋窝淋巴结转移的乳腺癌２２６例的ＥＲ阳性率为４５．５％,二者的差异有非常显著的意义（Ｐ〈０．０     

胃癌淋巴转移规律与淋巴结清扫范围的分析(附326例报告)

目的 探讨胃癌淋巴结转称规律和胃癌根治术的淋巴清扫范围。方法 １９９０年～１９９９年行Ｄ２、Ｄ３、Ｄ３淋巴结廓清术加腹主动脉旁淋巴结廓汪术（Ｄ３加ＰＡＬ）的胃癌患者３２６例,对期临床资料进行回顾性分析。结果 本组总的淋巴结转移率６９．９％,早期与进展期胃癌淋巴结转移率分别为１５．４％和７７．４％。肿瘤浸润深度达Ｔ１的患者,淋巴结转移主要局限于Ｎ１;达Ｔ２的患者淋巴结转移至Ｎ３、Ｔ４的ＫＫＨＮＦＴＪ     

新辅助化疗对乳腺癌腋淋巴结及结外侵犯的影响

目的 旨在观察局部进展期乳腺癌新辅助化疗时腋淋巴结及结外侵犯的临床病理学改变.方法 2002年6月-2009年8月南京大学附属第二医院收治的肿块大于5 cm伴同侧腋淋巴结肿大但不融合的86例患者,以患者是否愿意行新辅助化疗分组,A组患者46例,不愿行新辅助化疗,穿刺确诊后行手术治疗,术后病理证实,腋淋巴结转移40例,转移腋淋巴结结外侵犯17例.B组患者40例,自愿行新辅助化疗,穿刺确诊后平均行3个周期新辅助化疗,再行手术治疗,术后病理证实,腋淋巴结转移26例,转移腋淋巴结结外侵犯6例.结果 A组患者淋巴结转移率为86.9%,转移淋巴结并结外侵犯率为36.9%;B组患者淋巴结转移率为65%,转移淋巴结结外侵犯率为15%,两组病例在淋巴结转移率及转移淋巴结结外侵犯率之间存在显著差异,P<0.05.结论 新辅助化疗对于患者的腋淋巴结转移灶有明显作用,减少了淋巴结转移率及转移淋巴结结外侵犯率.     

Evidence-based medicine applied to sentinel lymph node biopsy in patients with breast cancer

Sentinel lymph node biopsy (SLNB) has not been examined using the principles of evidence-based medicine (EBM). Specifically, likelihood ratios have not been used to assess the validity of SLNB.The Surveillance, Epidemiology, and End Results (SEER) public database of the National Cancer Institute was used to establish the baseline or pretest probability of finding a positive lymph axillary node for each stage of breast cancer. Rates of false negative results of SLNB for all breast cancer stages were determined from the surgical literature. Positive and negative likelihood ratios (LR) were calculated. For each stage of breast cancer, the Bayesian nomogram was used to find the post-test probability of missing a metastatic axillary node when the SLN was negative. The SEER database of 213,292 female patients with breast cancer yielded the following rates of positivity of axillary lymph nodes for each breast tumor size: T1a, 7.8 per cent; T1b, 13.3 per cent; T1c, 28.5 per cent; T2, 50.2 per cent; T3, 70.1 per cent. The combined data from 13 published studies of SLNB (6444 successful SLNBs) demonstrated a false negative rate of 8.5 per cent. The LR of a negative test is 0.086. According to the nomogram, the chances of missing a positive node for stage of cancer are as follows: T1a, 0.7 per cent; T1b, 1.5 per cent; T1c, 3.0 per cent; T2, 7 per cent; T3, 18 per cent. The risk of missing a positive axillary node can accurately be estimated for each stage of breast cancer using the LR, which is much more useful than the simple false negative rate. Surgeons should use this information when deciding whether to perform SLNB and in their informed consent discussions.     

Sentinel lymphadenectomy accurately predicts nodal status in T2 breast cancer

Background: Sentinel lymph node biopsy (SLNB) has emerged as a reliable, accurate method of staging the axilla for early breast cancer. Although widely accepted for T1 lesions, its use in larger tumors remains controversial. This study was undertaken to define the role of SLNB for T2 breast cancer.

Study Design: From a prospective breast sentinel lymph node database of 1,627 patients accrued between September 1996 and November 1999, we identified 223 patients with clinical T1-2N0 breast cancer who underwent 224 lymphatic mapping procedures and SLNB followed by a standard axillary lymph node dissection (ALND). Preoperative lymphatic mapping was performed by injection of unfiltered technetium 99 sulfur colloid and isosulfan blue dye. Data about patient and tumor characteristics and the status of the sentinel lymph nodes and the axillary nodes were analyzed. Statistics were performed using Fisher’s exact test.

Results: Two hundred four of 224 sentinel lymph node mapping procedures (91%) were successful. Median tumor size was 2.0 cm (range 0.2 to 4.8 cm). One hundred forty-five of the 204 patients had T1 lesions and 59 patients had T2 lesions. There were 92 pathologically positive axillae, 5 (5%) of which were not evident either by SLNB or by intraoperative clinical examination. The false-negative rate and accuracy were not significantly different between the two groups, but axillary node metastases were observed more frequently with T2 than with T1 tumors (p = 0.005); other factors, including patient age, prior surgical biopsy, upper-outer quadrant tumor location, and tumor lymphovascular invasion were not associated with a higher incidence of false-negative SLNB in either T1 or T2 tumors.

Conclusions: SLNB is as accurate for T2 tumors as it is for T1 tumors. Because no tumor or patient characteristics predict a high false-negative rate, all patients with T1-2N0 breast cancer should be considered candidates for the procedure. Complete clinical examination of the axilla should be undertaken to avoid missing palpable axillary nodal metastases.     

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。     

乳腺癌新辅助化疗后原发灶临床完全缓解对腋淋巴结转阴的预测作用

目的 判断腋窝淋巴结阳性乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)后原发灶临床完全缓解能否预测腋窝淋巴结病理转阴.方法 2016年10月 ～2019年10月收治的乳腺癌病人95例,淋巴结穿刺均阳性,临床分期T1-3,N1-2期,且均完成NAC后有腋窝淋巴结清扫(axillary lym...     

Sentinel node biopsy in breast cancer

Background: Sentinel lymph node biopsy (SNB) in breast cancer may be used in place of axillary lymph node dissection (ALND) if SNB accurately stages the axilla. This study assessed the success and accuracy of axillary SNB with isosulfan blue (ISB) and technetium-99 sulfur colloid (TSC) compared to ALND. Methods: Forty-two women with T1 or T2 breast cancer underwent SNB and ALND. Sixty to 90 minutes before anesthetic induction, a mixture of 3 mL ISB and 1 mCi TSC was injected around the primary cancer or prior biopsy site. Intraoperatively, the SLN was identified using a gamma detector (Neoprobe 1000) or by visualization of the blue-stained lymph node and afferent lymphatics. The SLN was excised separately, and a level I/II ALND was completed. The histologic findings of the axillary contents and SLN were compared. Results: An axillary SLN was found in 38 of 42 (90%) cases. SLN localization rate and predictive value were the same for women who had and those who had not undergone excisional biopsy before the date of SNB. Fifteen of 42 (36%) patients had lymph node metastases. The SLN was positive in all women with axillary metastases (negative predictive value, 100%). Conclusions: If confirmed by larger series, a negative SNB may eliminate the need for ALND for select women with breast cancer. Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

乳腺癌前哨淋巴结活检

目的 评价前哨淋巴结活检预测腋窝淋巴结有无肿瘤转移的准确性及其临床意义。方法 用^99m锝－硫胶体作为示踪剂,用γ探测仪导向,对70例临床分期为T1－2N0M0的乳腺癌患者进行前哨淋巴结活检,所有的患者均同时行腋窝淋巴结清扫,HE染色阴性的前哨淋巴结再切片,用CK8、CK19、KP－1行免疫组织化学染色。结果 70例患者中成功发现前哨淋巴结的有67例,发现率为95.7%（67／70）。前哨淋巴结的数量为1－5枚,平均每例1.6枚。非前哨淋巴结5－20枚,平均例12.3枚。67例前哨淋巴结活检成功的患者中,29例患者（43.3%）有腋窝淋巴结转移,其中前哨淋巴结有转移者24例（35.8%）,前哨淋巴结未发现转移而非前哨淋巴结有转移者5例（7.5%）。7例患者（10.4%）只有有淋巴结为阳性淋巴结,前哨淋巴结活检的准确性为100％。43例患者的65枚HE染色阴性一的前哨淋巴结,CK8及CK19免疫组织化学染色均为阴性。结论 前哨淋巴结检能较准确地预测腋窝淋巴结转移情况,对原发灶为T1的乳腺癌,前哨淋巴结活检的准确性为100％。同一层面切片行免疫组织化学染色并不能提高淋巴结微转移癌的发现率。     

新辅助治疗对雌激素受体低表达/人类表皮生长因子受体2阳性乳腺癌腋窝淋巴结状态的影响

目的评估人类表皮生长因子受体2（HER2）阳性乳腺癌患者接受不同新辅助治疗（NAC）方案后腋窝淋巴结病理缓解情况及影响因素。 方法纳入2010年11月至2015年12月中山市人民医院收治的100例HER2阳性、Ⅱa~Ⅲc期乳腺癌患者，在NAC前通过触诊和细针穿刺（FNA）评估腋窝淋巴结状态。所有患者接受4~6个周期的PCrb（紫杉醇175 mg/m²和卡铂AUC=6，每3周），部分患者接受联合曲妥珠单抗（6 mg/kg每3周，首剂8 mg/kg）。 结果62例通过FNA确定为腋窝淋巴结阳性（A组），38例通过FNA或触诊确定为腋窝淋巴结阴性（B组）。其中A组总体腋窝淋巴结病理阴性率（pNNR）为53.2％，B组为71.1％。雌激素受体（ER）低表达/HER2阳性患者的pNNR最高，A组为81.0％，B组86.7％。多因素分析显示，联合曲妥珠单抗和ER状态是预测HER2阳性乳腺癌pNNR的独立因素。 结论对于治疗前腋窝淋巴结阳性的乳腺癌患者，如果NAC联合靶向治疗后前哨淋巴结阴性，ER低表达/HER2阳性就不需要腋窝淋巴结清扫。     

Axillary lymph node metastases in patients with small carcinomas of the breast: is accurate prediction possible?

OBJECTIVES: To find out whether macroscopic classification of the tumour margin is predictive of axillary lymph node metastases and to identify a combination of clinical and pathological findings by which axillary node status can be predicted accurately in small carcinomas (T1) of the breast. DESIGN: Retrospective study. SETTING: Municipal referral centre, Japan. SUBJECTS: All 1003 patients with T1 invasive carcinoma of the breast who had axillary lymph node dissection between January 1970 and December 1996 as part of their treatment. MAIN OUTCOME MEASURES: The association between the incidence of axillary lymph node metastases and 10 clinical and pathological factors (age, palpability and size of tumour, macroscopic classification of tumour margin, clinical axillary status, radiating spiculation on a mammogram, histological type, lymphatic invasion, oestrogen and progesterone receptor status) were analysed. RESULTS: Clinical axillary node status, macroscopic classification of tumour margin, lymphatic invasion, and age of the patient were significant predictors of axillary lymph node metastases (p < 0.01 in each case). Among 47 patients aged 65 or more whose tumours had well-defined margins and with a clinical N0 status in the axillae, the incidence of histological axillary lymph node metastasis was only 6% (n = 3) whereas it was 65% in 57 patients with tumours of ill-defined margins whose axillae were N1 or N2. CONCLUSIONS: Macroscopic classification of tumour margins is an independent predictor of axillary lymph node metastases for patients with small carcinomas of the breast. However, even with combinations of the examined predictors of axillary node metastases, the subgroup of patients at minimal risk of metastasis was less than 5% in T1 breast cancer, whereas three-quarters of the patients had clear axillary lymph nodes. Most patients with T1 breast cancer will need surgical staging of the axillae by methods such as sentinel node biopsy.     

乳腺癌行腋窝淋巴结清扫规范、争议与共识

乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移（cN0）的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。     

T1期乳腺癌前哨淋巴结活检41例报告

目的 探讨前哨淋巴结活检术(sentinel lymph node biopsy，SLNB)在乳腺癌治疗中的应用。方法 使用美蓝染色，对2001年9月至2002年8月连续收治的41例T1期乳腺癌，临床检查腋窝淋巴结阴性的病人行前哨淋巴结活检术。结果 SLNB成功率87．8％(36／41)，假阴性率5．88％(1／17)，准确率97．2％(35／36)。结论 SLNB能够准确预测T1期乳腺癌腋窝淋巴结的转移情况，在缩小手术范围、减少术后并发症的同时，提高了腋窝淋巴结分期的准确性。