乳腺癌前哨淋巴结定位活检的意义（附68例分析）

目的：验证乳腺癌前哨淋巴结（SLN）定位和活检技术的可行性及前哨淋巴结的组织化学状况是否能准确预告腋淋巴结转移特性,方法：使用美蓝等对68例确认为乳腺癌患进行术中前哨淋巴结定位活检术,结果：58例（85．3％）SLN,SLN预告腋淋巴结的准确率为91．4％（53／58）,假阴性为8．6％（5／58）,结论：乳腺癌SLN定位活检是可行的,SLN可较为准确地反映腋淋巴结状况。     

乳腺癌前哨淋巴结定位活检的意义(附68例分析)

目的验证乳腺癌前哨淋巴结(SLN)定位和活检技术的可行性及前哨淋巴结的组织学状况是否能准确预告腋淋巴结转移特性.方法使用美蓝等对68例确认为乳腺癌患者进行术中前哨淋巴结定位活检术.结果 58例(85.3%)SLN,SLN预告腋淋巴结的准确率为91.4%(53/58),假阴性为8.6%(5/58).结论乳腺癌SLN定位活检是可行的,SLN可较为准确地反映腋淋巴结状况.     

乳腺癌前哨淋巴结活检术前临床可疑腋淋巴结超声引导针吸细胞学检测的临床意义

目的:评估腋淋巴结可疑阳性的乳腺癌患者,在前哨淋巴结活检术前行超声引导腋淋巴结针吸细胞学检测的临床意义。方法:回顾性分析了257 例超声提示腋淋巴结异常或腋淋巴结临床查体可触及的原发性乳腺癌患者的腋淋巴结针吸细胞学检测结果及常规病理结果。结果:超声引导腋淋巴结针吸细胞学检测乳腺癌可疑腋淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为76.3% 、100% 、80.9% 、100% 和50.5% 。76.3% 的患者通过针吸细胞学检测准确地预测了腋淋巴结转移,避免了接受前哨淋巴结活检术。50.5% 的超声提示腋淋巴结异常但针吸细胞学阴性的患者可接受前哨淋巴结活检术替代腋淋巴结清扫术。结论:超声引导腋淋巴结穿刺针吸细胞学检测可快速、较为准确地判定乳腺癌患者腋淋巴结的状况,应该作为前哨淋巴结活检术前的筛查手段。      

美蓝法乳腺癌前哨淋巴结活检的手术配合

目的：探讨美蓝法乳腺癌前哨淋巴结活检技术（Sentinel lymph node biopsy，SLNB）的可行性及其与手术的配合。方法：本组32例T1、T2患者均先行乳腺区段切除，送快速冰冻病理活检，回报确诊为乳腺癌后于术中应用美蓝行前哨淋巴结活检，同时进行腋淋巴结清扫（Axillary lymph node dissection．ALND）。术后对全部前哨淋巴结（SLN）和腋淋巴结（ALN）行常规病理检查。结果：32例中检出SLN者29例，检出率为90．63％（29／32），本组准确率为84．38％（27／32）；灵敏度为91．67％（11／12），即预测符合率；假阴性率为16．67％（2／12）；假阳性率为0。结论：应用美蓝示踪定位SLNB，能准确预测T1、T2乳腺癌患者的腋淋巴结转移状况，与手术配合易于控制活检的时间，成功率较高。     

美蓝在乳腺癌前哨淋巴结活检中的应用研究

目的探讨美蓝在乳腺癌前哨淋巴结活检（SLNB）中的可靠性、准确性及其临床应用价值。方法用美蓝对45例乳腺癌患者行SLNB，临床腋淋巴阳性，肿块分期为T4，或怀疑有多病灶性乳腺癌者除外。结果45例33例成功定位活检到前哨淋巴结，成功率73．3％。共100个前哨淋巴结，平均每例3．03个。15例前哨淋巴结呈阳性，其中6例前哨淋巴结为唯一阳性，3例前哨淋巴结阴性而腋窝清扫淋巴结阳性，即假阴性，假阴性率为16．6％。结论美蓝可以较准确地检测出前哨淋巴结，可单独用于乳腺癌前哨淋巴结的定位活检。前哨淋巴结作为第一个接受淋巴转移的淋巴结，能很好地反映区域淋巴结的转移状况。     

核素标记法联合亚甲蓝在早期乳腺癌前哨淋巴结活检中的应用价值

[目的]探讨核素标记法联合亚甲蓝在早期乳腺癌前哨淋巴结活检中的临床应用价值。[方法]对65例临床确诊的早期乳腺癌患者联合应用99mTc-硫胶体和亚甲蓝标记法进行前哨淋巴结活检,并行腋淋巴结清扫术。[结果]前哨淋巴结活检成功率为100.00%,准确率98.46%,假阴性率6.25%。[结论]核素标记和亚甲蓝联合定位法在前哨淋巴结活检中具有明确的实用性,能有效预测早期乳腺癌腋窝淋巴结转移状况。     

胃癌前哨淋巴结定位及活检技术

目的：确定胃癌前哨淋巴结定位及活检技术的可行性及其预测各期胃癌淋巴结转移情况的准确性。方法：使用专利蓝染料，对45例胃癌病人进行术中及术后前哨淋巴结定位和活检。结果：在44例（97．78％）中找到前哨淋巴结。有15例前哨淋巴结存在转移，其中10例非前哨淋巴结亦存在转移。5例前哨淋巴结为胃周淋巴结的唯一转移部位。有29例前哨淋巴结无转移，其中4例非前哨淋巴结存在转移。由前哨淋巴结状态预测胃周淋巴结转移情况的敏感性为78．95％，特异性为100％，准确率为90．91％。随着肿瘤增大，浸润程度加深，其特异性不变，但准确率下降。结论：胃癌前哨淋巴结定位及活检技术是可行的，对于早期胃癌，前哨淋巴结的组织学状态可以准确反映胃周其余淋巴结的状况。将来治疗淋巴结转移阴性的胃癌中，这一技术有可能免除常规的淋巴结清扫。     

乳腺癌术中前哨淋巴结印片细胞学的评估

乳腺癌的手术治疗发生了巨大的变化,前哨淋巴结活检是其中之一。前哨淋巴结活检可准确评估区域淋巴结状态,从而避免在腋淋巴结阴性乳腺癌中行腋淋巴结清扫术,减少手术的并发症。乳腺癌前哨淋巴结术中病理学诊断是目前限制前哨淋巴结发展成为乳腺癌的手术规范的主要原因之一,如果能够进行准确地术中诊断,就可以避免再次手术。本文对乳腺癌前哨淋巴结的术中诊断的两种主要方法印片细胞学与冷冻切片的优缺点进行比较,回顾相关机构进行术中诊断的研究结果,并且对印片对诊断前哨淋巴结中存在的问题以及可能改进的方向进行初步的探讨。     

167例乳腺癌前哨淋巴结^99mTc-DX联合显像的临床分析

目的研究^99mTc-DX显影联合蓝染法及γ探测法在乳腺癌前哨淋巴结活检技术或淋巴结清扫手术中的应用价值。方法 167例乳腺癌患者于术前14～16h注射^99mTc-DX37～74MBq（1～2mCi）进行乳腺癌前哨淋巴结显影和定位,术中根据^99mTc-DX定位标记,利用蓝染法及γ探测法寻找活检或清扫乳腺癌前哨淋巴结,以病理为基础,统计活检或清扫乳腺癌前哨淋巴结的定位成功率。结果 ^99mTc-DX显影乳腺癌前哨淋巴结定位成功率为87.4%,^99mTc-DX显影联合蓝染法及γ探测法检测乳腺癌前哨淋巴结的成功率为91.6%,假阴性率为4.6%。结论 ^99mTc-DX显影体表定位可以准确显示乳腺癌前哨淋巴结的部位、数目及淋巴引流情况,可用于指导术中用γ探测定位乳腺癌前哨淋巴结活检或清扫。     

乳腺癌腋淋巴结抽样和亚甲蓝示踪前哨淋巴结活检的对照研究

目的了解早期乳腺癌腋淋巴结抽样检查和亚甲蓝示踪前哨淋巴结活检的临床价值。方法2008年1月至2008年8月,对100例临床腋淋巴结阴性的早期乳腺癌患者进行腋淋巴结抽样检查和亚甲蓝示踪前哨淋巴结活检,然后行腋淋巴结切除,并对其结果进行统计学比较。结果腋淋巴结抽样检查的检出率为99％（99／100）,高于前哨淋巴结活检的检出率（84％,84／100）。两种方法的正确率和假阴性率分别为：97％（96／99）和94％（79／84）,10．7％（3／28）和16．7％（4／24）,两者差异无统计学意义。结论腋淋巴结抽样检出率明显高于前哨淋巴结的检出率,该方法简便易行,不需特殊设备和药物,具有进一步研究价值。     

Lymphatic mapping and sentinel lymph node biopsy in the patients with breast cancer

Axillary lymph node dissection (ALND) is always standard part for a variety of surgical treatments of breast cancer. Knowledge of the status of axillary nodes presents important information for staging and prognosis, but it remains controversial that ALND provides local control of disease and offer survivalbenefit. Some authors have questioned the wisdom of continuing to do ALND, when the risk of axillary metastasis in the early case is small, and the postoperative complications are usuall…     

乳腺癌前哨淋巴结活检的可行性及临床应用价值

目的 探讨前哨淋巴结(sentinel Iymph node,SLN)定位和活检(SLNB)的可行性及其对预测乳腺癌腋窝淋巴结(axillary lymph node,ALN)转移的准确性。方法 对52例临床查体及B超检测ALN阴性的乳腺癌患者,术中在肿瘤周围注射亚甲蓝进行SLN定位和活检。对常规病理检查阴性的SLN再行免疫组化检测。结果 SLNB的检出成功率为92.3％(48/52),准确率为97.9％,假阴性率为4.8％,敏感度为95.2％,特异度为100％。SLN是惟一被证实有肿瘤转移的淋巴结者占66.7％(14/21)。免疫组化检测使SLN肿瘤转移的阳性率提高了4.1％。结论乳腺癌SLNB技术是可行的,应用亚甲蓝淋巴定位方法进行的SLNB可以准确预测临床及B超检查ALN阴性的乳腺癌患者的ALN转     

Sentinel lymph node biopsy in breast cancer using blue dye with or without isotope localization

BACKGROUND: The purpose of this study was to determine the feasibility of sentinel lymph node (SLN) biopsy using blue dye with or without isotope localization to predict the presence of axillary and internal mammary lymph node (IMN) metastases in patients with breast cancer. We also investigated whether multiple sectioning of the SLN could improve the accuracy of frozen section examination. METHOD:One-hundred twenty-six patients underwent dye-guided or dye- and gamma probe-guided SLN biopsy followed by complete axillary lymph node dissection (ALND). No ALND was performed in the 14 patients with small tumors and a negative SLN. In addition, 69 patients underwent IMN biopsy. RESULTS: The axillary SLN was identified in 123 of 140 (88%) patients. An accuracy rate of 90% was obtained by frozen section examination of the SLN, which increased to 100% in patients examined with a greater number of sections. Lymphatic flow to the IMN and/or a radioactive hot spot in the IMN was found in 9 of 102 (9%) patients, while a hot node was detected using a gamma probe in only 2 of these patients. No involvement of the IMNs was found histologically in these 9 patients. IMN involvement was found in 7 of 61 (11%) patients without lymphatic flow to the IMNs or a hot spot by lymphoscintigraphy or who did not undergo lymphoscintigraphy. CONCLUSION: ALND can be avoided in patients with small breast cancers and a negative SLN. SLN biopsy guided by lymphatic mapping is unreliable for identifying metastases to IMNs.     

国产亚甲蓝标记乳腺癌前哨淋巴结活检64例分析

[目的]评估乳腺癌前哨淋巴结活检（SLNB）对预测腋窝淋巴结转移状态的价值。[方法]64例临床Ⅰ、Ⅱ期原发女性乳腺癌，体检无腋淋巴结肿大或虽有肿大而估计非转移性，术中在原发肿瘤周围注射亚甲蓝示踪定位，进行SLNB和腋淋巴结清扫（ALND）。术后对全部前哨淋巴结（SLN）和腋淋巴结（ALN）行常规病理检查。[结果]64例中检出SLN者53例，检出率为82．8％。其中Nn组腋窝淋巴结预测准确度为91.4％，阳性预测符合率100％（5／5）；无假阴性，阴性预测符合率100％（30／30）。N1组准确度仅72．2％（13／18）。腋窝淋巴结肿大不影响SLNB成功率，但降低SLN预测ALN准确度；肿块切检后行SLNB可降低成功率；注射亚甲蓝后60min内解剖SLN不影响SLNB成功率。[结论]在肿块切检前注射亚甲蓝示踪定位，SLNB成功率高，能准确预测（T1，T2）N0M0乳腺癌患者的转移状态。     

美蓝在乳腺癌前哨淋巴结活检中的临床价值

目的探讨美蓝在乳腺癌前哨淋巴结活检中的临床价值。方法将1%美蓝2ml注入活检腔外上方的皮下及乳腺组织内,然后行Auchincloss仿根治术,依淋巴管走向找到蓝染淋巴结定为SLN,若此时未找到待腋窝清扫结束后,再在标本中寻找,蓝染者为SLN,余为非SLN,分别送病理检查。结果前哨淋巴结检出率为87.9%(95/108),SLN预测腋窝状况的准确率为95.7%(91/95),假阴性率为6.5%(4/62),无假阳性者。未检出者13例,其中4例为假阴性,均属跳跃式转移。前哨淋巴结转移阳性率(34.6%,33/95)和阴性率(65.3%,62/95),与全腋淋巴结转移阳性率(39.8%,43/108)和阴性率(60.2%,65/108)比较,均无显著性差异(P>0.05)。结论美蓝前哨淋巴结活检可以准确预测乳腺癌患者的腋淋巴结状态。     

Sentinel lymph node biopsy in patients with multifocal breast cancer.

BACKGROUND: Multifocal or multicentric breast cancer has been suggested as a contraindication for sentinel node biopsy (SNB). However, recent studies have demonstrated that all quadrants of the breast drain through common afferent channels to a common axillary sentinel node. This should mean that the presence of multifocal tumour should not affect the lymphatic drainage. The purpose of this study was to evaluate the feasibility and accuracy of SNB in patients with multifocal breast cancer using a peritumoural injection technique for sentinel lymph node (SN) mapping. METHODS: In the ALMANAC multicentre trial validation phase, we took SNB samples from 842 patients with node negative, invasive breast cancer with use of a blue dye and radiolabelled colloid mapping technique at the peritumoural injection site. All patients underwent standard axillary treatment after SNB. Seventy-five of the 842 patients had multifocal lesions on final histopathologic examination. The following analysis is focused on patients with multifocal lesions. RESULTS: A mean number of 2.4 SNs were identified in 71 of 75 patients (identification rate: 94.7%). Thirty-one patients had a positive SN, 40 a negative SN. Standard axillary treatment confirmed the SN to be negative in 37 of 40 patients, whereas three patients revealed positive non-sentinel lymph nodes (false-negative rate: 8.8%). Overall SN biopsy accurately predicted axillary lymph node status in 68 of 71 patients (95.8%). CONCLUSION: SNB accurately staged the axilla in multifocal breast cancer and may become an alternative to complete axillary lymph node dissection in node negative patients with multifocal breast cancer.     

Lymphatic mapping and sentinel node harvesting in patients with recurrent breast cancer

AIMS: To evaluate the feasibility and consequences of lymphatic mapping and a ("repeat") sentinel lymph node (SLN) procedure in patients with breast cancer relapse after previous breast and axillary surgery. METHODS: Review and presentation of a patient cohort. All SLN procedures included lymphoscintigraphy and blue dye injection technique. RESULTS: Twelve cases are described: two patients after a previous SLN procedure and ten after a previous complete axillary lymph node dissection (ALND). Ten patients (83%) had a successful repeat SLN biopsy. After previous ALND, lymphoscintigraphy revealed drainage towards the internal mammary chain in three patients, and contralateral axillary drainage in four. Based on the information from the "repeat" SLN biopsy further treatment strategy was altered in seven of the 12 patients. CONCLUSION: Lymphatic mapping and (repeat) SLN biopsy is possible and can be informative in patients who present with a relapse of breast cancer after previous surgery for primary breast cancer.     

Sentinel lymph node biopsy is feasible for breast cancer patients after neoadjuvant chemotherapy

BACKGROUND: Despite the increasing use of both sentinel lymph node (SLN) biopsy and neoadjuvant chemotherapy (NAC) in patients with operable breast cancer, information on the feasibility and accuracy of sentinel node biopsy following neoadjuvant chemotherapy is still quite limited. Therefore, we investigated the feasibility and accuracy of sentinel lymph node biopsy for breast cancer patients after NAC. METHODS: A total of 104 patients with Stage II and III breast cancers, previously treated by NAC, were enrolled in the study. All patients were clinically node-negative after NAC. The patients underwent SLN biopsy, which involved a combination of an intradermal injection of radiocolloid and a subareolar injection of blue dye over the tumor. This was followed by completion axillary lymph node dissection (ALND). RESULTS: SLN could be identified in 97 of 104 patients (identification rate, 93.3%). In 93 of the 97 patients (95.9%), the SLN accurately predicted the axillary status. Four patients' SLN biopsies were false negative, resulting in a false-negative rate of 10.0%. The SLN identification rate tended to be lower among patients with T4 primary tumors prior to NAC (62.5%). CONCLUSION: The SLN identification and false-negative rates were similar to rates in non-neoadjuvant studies. The SLN accurately predicted metastatic disease in the axilla of patients with tumor response following NAC.     

核素淋巴显像识别前哨淋巴结在乳腺癌治疗中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌中确定前哨淋巴结(SLN)的应用价值,验证前哨淋巴结活检替代腋窝淋巴结清除术用于乳腺癌治疗的安全性与价值。方法选择1999年6月至2009年11月本院住院的女性乳腺癌患者206例(体检时腋窝均未扪及肿块),应用99Tcm-DX37～74 MBq或99Tcm-SC74 MBq经皮下注射,行核素淋巴显像后,术中注射专利兰1 ml和(或)术中用γ探针定位并行前哨淋巴结活检,与术中冰冻病理检查结果对照。若术中冰冻发现有前哨淋巴结转移,则行腋窝淋巴结清除术,若前哨淋巴结阴性,则不做腋窝淋巴结清除,术后定期随访。结果 206例乳腺癌术中成功活检SLN204例,成功率为99.0%(204/206)。本组有64例仅行SLN切除,术后病理检查证实64例SLN均阴性,故未行腋窝淋巴结清除,其中仅1例于术后1年时出现腋窝淋巴结转移,其余63例患者在随访期间均未发现腋窝淋巴结转移,也未出现同侧上肢水肿、感觉及活动异常;另140例行腋窝淋巴结清除,其中6例经病理证实SLN阳性但腋窝淋巴结为阴性,134例经病理证实SLN阳性35例,阴性99例,腋窝淋巴结阳性37例,阴性97例。核素淋巴显像和γ探针定位法的灵敏度为94.6%(35/37例),准确率为98.5%(138/140),假阴性为5.4%(2/37)。结论核素淋巴显像和γ探针定位应用于乳腺癌是切实可行和可能的,对预测腋窝淋巴结转移有很大的临床实用价值。如技术方法规范,早期乳腺癌前哨淋巴结活检则能取代常规的腋窝淋巴结清除术,乳腺癌手术上肢并发症的发生率可大大降低。