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     

乳腺癌前哨淋巴结活检的研究进展

腋窝淋巴结清扫（axillary lymph nodes dissection，ALND）一直是乳腺癌外科治疗中不可缺少的组成部分，对乳腺癌临床分期、判断预后、指导治疗和防止局部复发具有重要的临床价值。但随着腋窝淋巴结阴性的早期乳腺癌发病比例逐年增高，ALND的治疗意义也逐渐下降，还可导致术后许多并发症，影响了患者的肢体功能和生活质量。因此，越来越多的学者对乳腺癌常规行ALND的必要性提出质疑。随着对前哨淋巴结活检（sentinel lymph node biopsy，SLNB）技术研究的不断深入，已有越来越多的医生和医疗机构接受了这一全新的概念和技术。     

早期乳腺癌治疗中前哨淋巴结活检应用价值探讨

自1894年Halsted创立乳腺癌根治术以来，无论术式如何发生变化，腋窝淋巴结清扫（axillary lymph nodesdissection，ALND）一直是手术讨论的重点。其对临床分期、判断预后、指导治疗和防止局部复发具有重要临床价值。但早期乳腺癌腋窝淋巴结阴性率在70％以上，对此类病人，ALND非但不能达到治疗目的，反可导致术后许多并发症，影响功能和生活质量。因此，越来越多的学者对早期乳腺癌常规行ALND的必要性提出了质疑。近年来，     

乳腺癌前哨淋巴结活检研究现状及进展

目的探讨乳腺癌前哨淋巴结活检(SLNB)技术的研究现状和进展。方法复习近年来国内、外的有关文献,对乳腺癌SLNB的定位、检取、状态评估、适应证和并发症进行分析与综述。结果乳腺癌SLNB能够准确定位、检取前哨淋巴结(SLN)。影像学检查和病理检测技术的发展有助于SLN状态的评估,SLNB的适应证正在不断扩大。该技术并发症少,能够准确判定腋窝分期,指导选择性的腋窝淋巴结清扫。结论 SLNB技术已成为乳腺癌外科治疗的重要手段,但其操作尚需进一步规范,以降低假阴性的发生;假阳性和有争议的适应证问题仍需继续关注。     

乳腺癌前哨淋巴结活检的研究进展

目的总结乳腺癌前哨淋巴结活检（SLNB）的研究现状和进展。方法复习近年来国内外的相关文献,对乳腺癌SLNB的概念、适应证、活检技术、提高检出准确率的方法、病理学检查方法、转移灶类型、临床应用等进行综述。结果 SLNB的适应证在不断扩大。示踪剂、影像学检查和病理学检查技术的发展有助于对乳腺癌前哨淋巴结（SLN）状态的评估。乳腺癌SLNB的操作方法还没有统一的标准,对其能否指导选择性的腋窝淋巴结清扫的争议较大,且SLNB的SLN检出率及假阴性率变化范围较大。结论 SLNB已成为乳腺癌外科治疗的重要辅助手段,但其操作尚需进一步规范,其临床应用范围还需要大量前瞻性、多中心的随机试验进一步论证。     

腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的系统评价

目的系统评价腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的有效性和安全性。方法检索CNKI、PubMed、EMBASE、CBM从建库至2013年12月1日的文献资料,选择腋窝淋巴结清扫术和前哨淋巴结活检术治疗乳腺癌患者的试验,严格按照制订纳入和排除标准对纳入的研究进行筛选、资料提取、质量评价和结果分析。使用Revman 5.1软件,进行统计学分析(Meta-分析)。结果最终纳入10篇文献,患者共7731例。因纳入文献在研究类型、测量指标、随访时间以及统计学指标的差异较大,采用亚组分析,Meta分析同质研究,其余采用定性的描述性分析。本研究结果显示,在无病生存率、总体生存率、局部复发率、远处转移率方面,不同随访时间腋窝淋巴结清扫术与前哨淋巴结切除术间差异均无统计学意义。结论对于单发浸润性乳腺癌患者前哨淋巴结活检呈阴性时,可不必行腋窝淋巴结清扫术。目前尚需相关高质量随机对照试验和长期的随访进一步证实此系统评价的结论。     

乳腺癌前哨淋巴结的病理检测

乳腺癌是全世界女性发病率最高的恶性肿瘤.腋窝淋巴结转移是乳腺癌最重要的预后指标[1].传统的腋窝淋巴结清扫术(axillary lymph node dissection,ALND)虽然对乳腺癌患者有治疗和预测预后的作用,但其副作用也是相当明显的.它可以导致乳腺癌患者出现患侧上肢水肿、疼痛、手臂运动功能障碍以及淋巴血管肉瘤等并发症,严重影响其生活质量[2-4].     

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。     

单蓝染料法示踪行乳腺癌前哨淋巴结活检的可行性

目的 探讨单独使用蓝染料法示踪行早期浸润性乳腺癌前哨淋巴结活检(SLNB)的可行性.方法 回顾性分析2015-01—2015-06新乡医学院第一附属医院SLNB学习曲线时的60例早期浸润性乳腺癌患者的临床资料.将沿蓝染淋巴管示踪找到蓝染淋巴结或蓝染淋巴管指向的第一个淋巴结的方法作为单蓝染料法.将术中γ探测仪检测超过淋巴...     

影响染料法乳腺癌前哨淋巴结活检成功率的一些因素

目的探讨影响染料法乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)成功率的因素及其可能机制.方法172例T1、T2乳腺癌病人,其中术前腋窝触及肿大淋巴结者16例.全身麻醉后,采用1%异硫蓝5 ml或美蓝4 ml,随机注入乳晕或肿瘤周围后行SLNB;然后作根治术或改良根治术,并将全部标本送病理学检查.比较病人年龄、腋窝淋巴结肿大、术前活检、肿瘤大小、组织类型、染料、注射部位、训练曲线等因素对SLNB检出率的影响.结果在术前触及腋窝淋巴结肿大的16例中,前哨淋巴结(sentinel lymph node,SLN)的检出率明显低于未触及者(x2=18355,P=0.000),而假阴性率则明显增高(X2=12.205,P=0.000).位于外上象限的肿瘤SLNB前行切除活检,SLN的检出率显著降低(x2=5.690,P=0.017).前30例SLN的检出率明显低于后142例(X2=5.807,P=0.016)病人的年龄、肿瘤位置、肿瘤大小、组织类型、染料以及注射部位等因素对SLNB成功率影响不大(P＞0.05).结论术前腋窝淋巴结肿大及SLNB前行外上象限肿瘤切除活检可明显影响SLNB的成功率,其原因可能与乳腺至腋窝之间的淋巴引流途径改变有关.通过训练可提高SLN的检出率.     

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。     

Accuracy of Sentinel Node Biopsy for Breast Cancer Using Blue Dye Alone

Abstract: Blue dye alone (BDA), lymphoscintigraphy alone, or, a combination of the two techniques are used for sentinel node biopsy (SNB) in breast cancer. This study reviews the effectiveness of the SNB technique using BDA by measuring the node identification rate and comparing the cohort node positivity with expected rates from established nomograms. A consecutive case series was examined from the database. This included the learning experience of six surgeons. Patients with unifocal tumors estimated at less than 31 mm were eligible. The tumor and axillary nodal histology was recorded. Published data were then used to calculate and predict node positivity rates in the study according to the size and grade of the tumors. There were 332 SNB procedures from 2001 to 2008. BDA successfully identified nodes in 94.6% (314/332) of the cases. The identification rate improved with experience. In patients with invasive cancer, 28.4% (85/299) of SNB were found to be positive for metastases or micrometastases. The node identification rate and the node positivity rate were found to be within published predicted ranges for the size and grade of the study tumors. The SNB with BDA was found to be effective in identifying sentinel nodes (SLN) in breast cancer. Surgeon experience was a factor in the success of the technique. Rates of detecting metastases were consistent with internationally published data, suggesting that BDA may perform as well as other techniques in experienced hands.     

Second Biopsy of Axillary Sentinel Lymph Node for Reappearing Breast Cancer After Previous Sentinel Lymph Node Biopsy

Background Sentinel lymph node biopsy (SLNB) is a safe and accurate axillary staging procedure for patients with primary operable breast cancer. An increasing proportion of these patients undergo breast-conserving surgery, and 5% to 15% will develop local relapses that necessitate reoperation. Although a previous SLNB is often considered a contraindication for a subsequent SLNB, few data support this concern. Methods Between January 2000 and June 2004, 79 patients who were previously treated at our institution with breast-conserving surgery and who had a negative SLNB for early breast cancer developed, during follow-up, local recurrence that was amenable to reoperation. Eighteen of these patients were offered a second SLNB because of a clinically negative axillary status an average of 26.1 months after the primary event. Results In all 18 patients (7 with ductal carcinoma-in-situ and 11 with invasive recurrences), preoperative lymphoscintigraphy showed an axillary sentinel lymph node, with a preoperative identification rate of 100%, and 1 or more SLNs (an average of 1.3 per patient) were surgically removed. Sentinel lymph node metastases were detected in two patients with invasive recurrence, and a complete axillary dissection followed. At a median follow up of 12.7 months, no axillary recurrences have occurred in patients who did not undergo axillary dissection. Conclusions Second SLNB after previous SLNB is technically feasible and likely effective in selected breast cancer patients. A larger population and longer follow-up are necessary to confirm these preliminary data.     

Sentinel Lymph Node Biopsy for Breast Cancer: Current Controversies

Abstract:   Sentinel lymph node biopsy (SLNB) has replaced the routine level I and II axillary lymph node dissection (ALND) for women with clinically node-negative T1 and T2 breast cancer. Studies have shown that SLNB is highly predictive of axillary nodal status with a false-negative of rate less than 10%. Our purpose was to address some of the ongoing controversies about this procedure, including technical issues, use of preoperative lymphoscintigraphy, internal mammary lymph node biopsy, criteria for patient selection (in intraductal carcinoma?), its staging accuracy, and the clinical approach when a SLNB was found to be negative or positive on pathologic examination. After the revision of the American Joint Committee on Cancer (AJCC) staging system for breast cancer in 2002, the evaluation of internal mammary lymph nodes and determination of micrometastases by hematoxylin-eosin or by immunohistochemistry have become increasingly important in staging of patients. Recent guideline recommendations developed by the American Society of Clinical Oncology (ASCO) Expert Panel in 2005 are also discussed. Long-term follow-up results of ongoing studies will provide more accurate assessment of the prognostic significance of SLNB and its value in the prevention of breast cancer-related morbidity in axillary staging compared to ALND.      

前哨淋巴结活检在结直肠癌的研究与进展

前哨淋巴结是指原发肿瘤淋巴引流的第一级淋巴结.由于前哨淋巴结是肿瘤转移的第一站淋巴结,因此可以代表整个区域淋巴结状态.最近前哨淋巴结活检技术已经被广泛应用于结直肠癌.通过染色等方法找到前哨淋巴结后对其进行详细病理检查,发现微小转移,对于指导手术切除范围、准确病理分期以及指导术后治疗等方面具有重要意义.     

美蓝染色法乳腺癌前哨淋巴结活检临床应用研究

目的探讨美蓝染色法在乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中的应用价值。方法以68例可手术乳腺癌患者作为研究对象,临床体检腋窝淋巴结阴性,均单独采用美蓝作为前哨淋巴结(sentinel lymph node,SLN)示踪剂。结果全组患者共检出SLN 60例78枚。检出后行乳腺癌改良根治术60例,乳腺区段切除+腋窝淋巴结(axillary lymph node,ALN)切除术8例。60例中22例SLN病理结果为阳性,转移淋巴结数28枚,SLN转移率为35.9%(28/78)。全组患者共检出ALN805枚,其中24例病理结果阳性。SLNB的检出率为88.2%(60/68),60例成功检出患者中,38例SLN阴性,其中经病理检查ALN阳性(假阴性)者1例,8例未找到SLN患者中亦有1例ALN阳性。SLNB灵敏度为91.7%,准确率为98.3%,假阴性率为8.3%,假阳性率为0。结论应用美蓝进行SLN的认定是安全可行的,并有利于简化手术方式,提高患者术后生活质量。     

乳腺癌前哨淋巴结活检的初步体会

目的 初步探讨乳腺癌前哨淋巴结（sentinel lymph node,SLN)检测的可行性,SLN预测腋窝淋巴结状态的可靠性。方法 对我院普外科收治的15例T1-2期、腋窝未扪及肿大淋巴结的乳腺癌病人,使用^99mTc右旋糖酐或^99mTc硫胶体为示踪剂,γ探测仪探测SLN,然后进行活检和腋窝淋巴结清扫（axillary lymph node dissection,ALND)。两处标本同时送病理检查,以此来评价SLN的病理组织学结果能否准确地反映腋窝淋巴结状态。结果 在10例病人中发现SLN,发现率为66.6%(10/15),SLN的数量为1-3枚/例,平均2.1枚/例,非前哨淋巴结（non-sentinel lymph node,NSLN)5-16枚/例,平均10.3枚/例,发现SLN的10例病人中1例（10%）SLN有癌转移,其他腋窝淋巴结未见转移;2例SLN未发现癌转移而NSLN有癌转移,假阴性率20%（2/10）,准确性80%（8/10）,结论 乳腺癌前哨淋巴结定位和活检技术以及预测腋窝淋巴结状态的可靠性方面有待进一步积累经验,提高准确性,降低假阴性率。     

γ探测仪在乳腺癌前哨淋巴结定位活检中的应用

目的:探讨γ探测仪在临床腋窝淋巴结阴性乳腺癌前哨淋巴结定位活检术(SLNB)中的临床应用价值.方法:利用99m锝-右旋糖酐(99mTc-DX)作为前哨淋巴结(SLN)示踪剂,应用γ探测仪定位对29例临床腋窝淋巴结阴性乳腺癌病人实施SLNB,随后进行常规腋窝淋巴清扫术,分析SLNB对腋窝淋巴结转移状态的预测价值.结果:本组SLN转移率为41.67%,非SLN转移率仅为22.54%,两者有明显差异(P＜0.001).在19例常规病理SLN阴性病人中,连续切片发现2例SLN微转移.在12例SLN癌转移中,5例(41.66%)SLN为惟一的转移部位.有1例SLN阴性病人"跳跃转移".本组SLN的敏感性为92.31%,特异性为94.12%,假阴性为7.69%,准确率达96.55%.结论:SLN能准确反映早期乳腺癌腋窝淋巴结转移状态,连续切片能提高SLNB的准确性.     

Pre‐mastectomy Sentinel Lymph Node Biopsy: A Strategy to Enhance Outcomes in Immediate Breast Reconstruction

The pre‐mastectomy sentinel lymph node biopsy (PM‐SLNB) is a technique that provides knowledge regarding nodal status prior to mastectomy. Because radiation exposure is associated with poor outcomes in breast reconstruction and reconstructed breasts can interfere with the planning and delivery of radiation therapy (RT), information regarding nodal status has important implications for patients who desire immediate breast reconstruction. This study explores the safety and utility of PM‐SLNB as part of the treatment strategy for breast cancer patients desiring immediate reconstruction. We reviewed the charts of adult patients (≥18 years old) who underwent PM‐SLNB from January 2004 to January 2011 at our institution. PM‐SLNB was offered to patients with stage I or IIa, clinically and/or radiographically node‐negative breast cancer who desired immediate breast reconstruction following mastectomy. PM‐SLNB was also offered to patients with ductal carcinoma in situ if features concerning for invasive carcinoma were present. Ninety‐one patients underwent PM‐SLNB of 94 axillae. PM‐SLNB was positive in 25.5% of breasts (n = 24). Nineteen node‐positive patients (79.2%) have undergone or planning to undergo delayed reconstruction at our institution. Seventeen of these 19 node‐positive patients (89.5%) have received adjuvant RT. Two patients (10.5%) elected against RT despite our recommendation for it. No biopsy‐positive patient underwent immediate reconstruction or suffered a radiation‐induced complication with their breast reconstruction. There were two minor complications associated with PM‐SLNB, both in node‐negative patients. This study demonstrates the utility of PM‐SLNB in providing information regarding nodal status, and therefore the need for adjuvant RT, prior to mastectomy. This knowledge can be used to appropriately counsel patients regarding optimal timing of breast reconstruction.     

Predictors to Assess Non‐Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastasis

Abstract: The next step of sentinel lymph node biopsy (SLNB) in breast cancer is to determine which patients need axillary lymph node dissection (ALND) following a positive SLNB. A prospective database of 239 patients who underwent SLNB followed by complete ALND at Keio University Hospital from January 2001 to June 2005 was reviewed. A total of 131 patients with one or more positive sentinel lymph nodes (SLNs) were further analyzed. A univariate analysis showed a significant correlation between non‐SLN involvement and lymphatic invasion, vascular invasion, number of tumor‐involved SLNs, radioactivity of SLNs, and size of SLN metastasis (p = 0.0002, p = 0.004, p = 0.006, p = 0.04, p = 0.03, respectively). By multivariate analysis, lymphatic invasion and the number of tumor‐involved SLNs remained significant predictors of non‐SLN involvement. In breast cancer patients with a positive SLN, lymphatic invasion and the number of tumor‐involved SLNs were both independent predictors of non‐SLN involvement.