Current technical overviews of sentinel lymph node biopsy for breast cancer.

Sentinel lymph node biopsy (SLNB) is based on the hypothesis that the sentinel lymph node (SLN) reflects the lymph-node status and a negative SLN might allow complete axillary lymph node dissection (ALND) to be avoided. Although the survival outcome is still unknown, this technique has already become a standard of care for breast cancer patients. However, it is still important to discuss current techniques and some controversies. This article reviews these issues for a variety of SLNB techniques.     

Current technical overviews of sentinel lymph node biopsy for breast cancer

Sentinel lymph node biopsy (SLNB) is based on the hypothesis that the sentinel lymph node (SLN) reflects the lymph-node status and a negative SLN might allow complete axillary lymph node dissection (ALND) to be avoided. Although the survival outcome is still unknown, this technique has already become a standard of care for breast cancer patients. However, it is still important to discuss current techniques and some controversies. This article reviews these issues for a variety of SLNB techniques.     

乳腺癌前哨淋巴结的研究现状与评价

前哨淋巴结活检为乳腺癌患者提供了精确的分期,并且减少了手术并发症,因此日益为临床所接受。但是在临床研究中,前哨淋巴结活检的方法、适应证尚有一些争议。本文就前哨淋巴结活检技术、前哨淋巴结病理学评估、前哨淋巴结活检的适应证和前哨淋巴结活检取代腋淋巴结清扫等几方面进行讨论,明确了同位素和染料示踪剂可以互补,淋巴核素显像对于内乳前哨淋巴结活检的价值,内乳前哨淋巴结活检目前仍处于临床研究阶段;术中前哨淋巴结的病理学评估方法中,细胞学印片显示了快速、廉价、节省组织材料等优点,但对微转移灶的识别仍有不足;前哨淋巴结有微转移的患者目前仍应进行腋淋巴结清扫。导管内癌、预防性乳房切除、乳房缩小成型术及隆乳手术后患乳腺癌的患者,有必要进行前哨淋巴结活检;虽然NSABPB32、Z0010、Z0011等大样本前瞻性随机临床试验结果要等待许多时间,但是乳腺癌前哨淋巴结活检已在临床上广泛开展,我们必须重视技术的规范和病例的选择。     

乳腺癌前哨淋巴结活组织检查术的研究进展

乳腺癌是全世界女性最常见的恶性肿瘤之一,严重威胁女性的健康和生命。乳腺癌的外科治疗不断向＂最小最有效＂的模式发展,前哨淋巴结（SLN）活组织检查术（SLNB）在此背景下应运而生。SLNB可免除腋窝淋巴结清扫术（ALND）,大大减少了ALND的并发症。近年来,一些临床研究结果提示部分SLN阳性乳腺癌患者即使不接受ALND,其预后也未受到影响,SLN阳性乳腺癌患者是否一定要行ALND的问题有待研究。     

Controversies in sentinel lymph node biopsy for breast cancer

Sentinel lymph node biopsy, validated in melanoma staging, is currently under investigation for breast cancer staging. Reports suggest that the sentinel lymph node has a high predictive value in determining the presence of axillary metastases. Identification of a sentinel lymph node that is free of metastatic tumor cells may eliminate the necessity of performing a standard axillary lymph node dissection with its attendant morbidity. Numerous techniques are utilized to identify the sentinel node with approximately the same success rate. This paper will address some of the controversial areas of sentinel lymph node biopsy and offer an option for physicians who want to develop a sentinel lymph node program in their hospital.     

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。     

乳腺癌前哨淋巴结活组织检查术的临床应用

随着乳腺癌基础与临床研究的深入,乳腺癌精准化治疗已成为必然趋势,而乳腺癌前哨淋巴结活组织检查术(SLNB)研究的不断深入以及临床应用的不断普及,更是为乳腺癌的精准医学治疗打下了坚实的基础。近年来,不断有临床研究表明SLNB的应用已经超出了早期乳腺癌的范围,并且已经适用于以前认为的禁忌证。笔者主要就SLNB在临床中的应用进行介绍。     

乳腺癌哨位淋巴结活检的临床意义

目的 探讨哨位淋巴结（sentinel lymph node,SLN)活检术（SLN biopsy,SLNB)指导临床腋淋巴结阴性（cNO)乳腺癌腋窝淋巴结游击队范围的可行性。方法 使用专利蓝或美蓝对1999年4月-2000年8月的96例cT1-3NOMO期乳腺癌患者进行SLNB,随后行包括全腋淋巴结清除的乳腺癌手术。结果 确定SLN91例,成功率为94.8%,SLＮ为１个者５4例,占59.3%;2个者23例,占25.3A%;3个以上者14例,占15.4%,91例中,24例（26.4%)SLN阳性,其中13例（54.2%)仅有SLN转移,SLNB的灵敏度为87.5%,特异度为100%,阳性结果预测值为100%,阴性结果预测值为95.7%,术中印片细胞学检查的准确率为92.1%,假阴性率为10.0%,假阳性率为7.1%;术中快速病理检查准确率为98.7%,假阴性率为5.0%,假阳性率为0,免疫组化未发现常规病理检查阴性的SLN有阳性结果。结论 SLN转移状况基本可反映乳腺癌腋淋巴结转移的状况;SLNB有望成为指导cNO期乳腺癌腋淋巴结清除范围的手术方法;国产美蓝对SLN标识效果与专利蓝相似。     

The evolving role of sentinel lymph node biopsy for breast cancer.

Recent studies have demonstrated that the sentinal node biopsy (SNB), which utilizes a simple principle, is a reliable and minimally invasive method for determining the status of the regional lymph nodes in patients with clinically node-negative breast cancer. The technique has been widely used in the management of patients with early breast cancer despite the lack of long-term data from randomised controlled trials which are currently in progress.The present article reviews the role of the SNB in the context of axillary node sampling and determines the requirements for its safe clinical application. It also highlights the need for further research to clarify the role of the SNB in high risk DCIS, the value of preoperative lymphascintigraphy, and the clinical relevance of internal mammary node dissection and focused examination of the sentinal node by immunohistochemistry and polymerase chain reaction.     

乳腺癌哨兵淋巴结活检影响因素的多因素分析

目的探讨影响乳腺癌哨兵淋巴结活检(sentinel lymph node biopsy,SLNB)成功率和假阴性率的因素.方法用美蓝(methylene blue)作为示踪剂,对330例术前临床分期为T1～T2N0M0的女性原发乳腺癌患者行SLNB,活检后立即行改良根治术或保乳手术.按病例入组时间的先后,将本研究分为3组:A组为第1～100例;B组为第101～200例;C组为第201～330例.Binary回归分析某些因素(患者的年龄、肿瘤的部位、腋淋巴结状况以及医师对SLNB的熟练程度等)与成功率和假阴性率的相关性.结果330例患者中成功发现哨兵淋巴结的有287例,成功率为87.0%.A、B、C 3组的成功率分别为79.0%、87.0%和93.1%.哨兵淋巴结活检的准确率为89.5%(257/287),假阴性率为10.5%(30/287).Binary Logistic回归分析显示腋淋巴结状况、肿瘤部位和医生的熟练程度是影响发现率重要因素(P均＜0.05).结论腋淋巴结状况和肿瘤部位是影响乳腺癌SLNB发现率重要的临床病理因素,医生对SLNB的熟练程度也对SLNB发现率有较大的影响.     

Lymphatic mapping and sentinel lymph node biopsy for breast cancer

Lymphatic mapping and sentinel lymph node mapping have changed the standard of surgical care for patients with melanoma and have the potential to do the same for women with breast cancer. The technique will result in more accurate disease staging and in less morbidity. Preoperative lymphoscintigraphy and the intraoperative mapping technique are being standardized across the country. With the lymphatic mapping technique, approximately 10% of the so-called histologic negative population will be more accurately staged. National trials are ongoing to determine the clinical significance of the missed micrometastatic     

乳腺癌前哨淋巴结活检示踪剂研究进展

传统的示踪剂核素和蓝染料存在一定缺点。近年来国内外学者试图研发一款功能优化的新型示踪剂,有助于前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)的推广。吲哚菁绿价格较低,使用安全,但穿透力有限(1 cm)且缺乏靶向性。超声造影剂可实时动态地观察显影淋巴管和淋巴结,但成功率和准确性相对较低。超顺磁氧化铁作为前哨淋巴结示踪剂,操作方便,可避免医源性核素污染,具有良好的应用前景。     

乳腺癌哨兵淋巴结检测

乳腺癌哨兵淋巴结(SLN)活检技术旨在提高生活质量,降低并发症及手术对患者损伤,并有望替代腋窝淋巴结清扫术.现综述有关乳腺癌哨兵淋巴结活检研究进展.     

淋巴显像在乳腺癌前哨淋巴结活检中的应用

目的：评价淋巴显像在乳腺癌前哨淋巴结活检中的价值。方法：采用肿瘤周围或皮下注射^99mTc标记的硫胶体的方法,先行术前淋巴显像,术中γ探测仪引导下行前哨淋巴结活检,分析影响其检出率的相关因素。结果：95例患者中,有88例（92．6％）在术前的淋巴显像中显示淋巴引流,其中39例（44．3％）患者有腋窝淋巴结以外的淋巴外流。术中在γ探测仪引导下成功发现前哨淋巴结的有91例（95．8％）。术前淋巴显像是清楚与前哨淋巴结检出率显著相关（P＝0．025）。结论：淋巴显像能发现腋窝以外的前哨淋巴结,联合使用淋巴显像与γ探测仪行前哨淋巴结活检的方法是可行的,值得在临床上推广使用。     

前哨淋巴结活检在乳腺癌治疗中的应用价值

目的　探讨前哨淋巴结活检 (sentinel lymph node biopsy,SL NB)在乳腺癌治疗中的可行性及准确性。方法　术前在乳腺肿瘤周围部位皮下注射放射性胶体 99m Tc- DX,同时运用核素淋巴显像和γ计数器探测仪探测两种检测方法 ,识别放射性同位素浓聚的前哨淋巴结 (sentinel lym ph node,SL N) ,将 SL N和其余淋巴结分别行病理组织学检查 ,分析影响 SL N检出率的相关因素。结果　 5 0例患者进行 SL N识别定位 ,发现 SL N 4 8例 ,检出率为96 .0 % ;敏感度为 88.2 % ;准确性为 95 .8% ;假阴性为 11.8% ;假阳性为 0。患者年龄 <5 0岁 ,原发肿瘤位于乳腺外上象限 ,术前穿刺活检确诊与 SL N检出有关 (P<0 .0 5 ) ;组织学因素与 SL N检出无关 (P>0 .0 5 )。结论　 SL N可以准确反映大多数乳腺癌患者腋窝淋巴结 (axillary lym ph node,AL N)的转移情况 ,有可能取代常规的腋窝淋巴结解剖 (axillary lymph node dissection,AL ND)。     

前哨淋巴结活检在乳腺癌病人中的应用

目的 探讨前哨淋巴结（sentined lymph node,SLN）定位和活检（SLNB）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 对本院自2004年6月至2006年6月收治的56例乳腺癌病人进行回顾,56例病人临床分期均为TmNoMo,术中在肿瘤周围或活检腔的正常乳腺组织皮下注射美蓝,进行SLN定位和活检。结果 SLNB的检出成功率为91．07％（51／56）,准确性为92．16％（47／51）,灵敏度为94．12％（32／34）,假阴性率为5．88％（2／34）,特异性为89．47％（17／19）。结论 用美蓝作SLN定位进行SLNB能准确预测乳腺癌腋窝淋巴结（ALN）转移状态。     

Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy

The surgical treatment of localized breast cancer has become progressively less aggressive over the years. The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered.