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。     

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。     

腋窝前哨淋巴结活检在早期乳腺癌中的应用

随着早期乳腺癌发现的增多,腋淋巴结阴性者也随之增多,再加上腋淋巴结清扫术的创伤大,术后上肢淋巴水肿、皮瓣感染、坏死等并发症较多,对腋淋巴结切除的范围存在争议〔１〕。而且腋淋巴结本身具有免疫监测功能,可起到一定的屏障作用,如果对无腋淋巴结转移的患者行腋淋巴结清扫,就会破坏这一屏障,从而使隐藏的癌灶更易向远处转移。那么对于这类无腋淋巴结转移的患者能否找到一种创伤小的方法予以证实则成为关注的问题。术前乳腺Ｘ线摄片、Ｂ超、ＣＴ等检查均能发现肿大的腋淋巴结,但不能提供病理学资料;腋淋巴结抽样活检（ａｘｉｌ…     

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     

腋窝溶脂术在乳腺癌前哨淋巴结活检术中的应用

1997年郑民华等[1]第一次将溶脂、吸脂术应用于乳腔镜技术中,此后对于乳腔镜腋窝淋巴结清扫术能否安全有效使用一直存在争议.2008年中华医学会外科学分会内分泌外科学组正式通过《治疗乳腺疾病腔镜手术技术操作指南》[2],其中对于腋窝溶脂、吸脂技术进行了具体的规范化的描述.腋窝溶脂术并非乳腺腔镜手术专有,也用于开放性手术.我院应用该技术对64例女性乳腺癌手术患者行前哨淋巴结(sentinel lymph node,SLN)活检,总结报道如下.     

早期乳腺癌前哨淋巴结活检术212例临床应用

选取212例早期乳腺癌患者,其中130例行前哨淋巴结活检术后继续行腋窝淋巴结清除术,82例患者仅行前哨淋巴结活检术.130例患者中,前哨淋巴结预测腋窝淋巴结转移正确率为90.77％,灵敏度95.0％,特异度88.9％,假阴性率5.0％,阳性预测价值79.2％,阴性预测价值97.6％.术后6、12个月,腋下仅行前哨淋巴结活检术乳腺癌患者的掖区疼痛、手术侧麻木或感觉异常、上肢水肿、手术侧上肢活动腋区皮肤明显牵拉感症状均低于腋下行淋巴结清除术患者（P＜0.05）.全部患者中位随访38个月,2组患者无瘤生存率差异无统计学意义（P＞0.05）.早期乳腺癌患者运用前哨淋巴结活检技术可以正确预测腋窝淋巴结情况,同时降低了腋窝淋巴结清除的并发症,提高了患者的生活质量.     

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…     

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。     

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。     

乳腺癌前哨淋巴结活检替代腋窝清扫术前瞻性非随机对照临床研究

目的：探讨前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）替代腋淋巴结切除术（axiHary lymph node dissection．ALND）的可行性。方法：联合应用亚甲蓝和^99mTc标记的硫胶体进行SLNB。2001年12月起山东省肿瘤医院乳腺病中心两个治疗组收治的临床T1.2N0M0乳腺癌病人进入本前瞻性非随机对照临床研究。A组病人SLNB后均行ALND。B组病人签署知情同意书，不同意SLNB替代ALND病人（B1组）治疗同A组；同意SLNB替代ALND病人（B2组）依据SLN状况，SLN阴性仅行SLNB，SLN阳性行ALND。结果：2001年12月-2005年6月共入组642例病人，其中A组114例（17．8％），B组528例（82.2％），B1组195例，B2组333例。B2组病人SLN阴性240例仅行SLNB；SLN阳性93例，其中87例接受ALND，另6例SLN镜下微小转移灶者中4例仅行SLNB，2例接受SLNB加区域淋巴结放疗。SLNB替代ALND者各项术后并发症显著低于ALND者（均P〈0．05）。B2组244例仅行SLNB病人中位随访26个月（7-48个月），2例病人发现区域淋巴结复发（0．82％），与ALND腋淋巴结阴性组病人（0％）相比差异无统计学意义（P〉0．05）。SLN术中冰冻快速病理诊断准确率98．5％，假阴性率5．4％。结论：SLNB可以缩小手术范围、减少病人术后并发症。SLN术中冰冻快速病理诊断具有较高的准确性，能够满足临床需要。     

乳腺癌前哨淋巴结检测的临床研究

目的通过前哨淋巴结(sentinel lymph node,SLN)活检,了解前哨淋巴结是否能反映乳腺癌腋窝淋巴结转移情况,从而决定是否行腋窝淋巴结清扫(axillary lymph node dissection,ALND). 方法 47例T1、T2、T3临床检查腋窝淋巴结无肿大的乳腺癌患者,术前30 min于乳腺肿块周围腺体注射蓝色染料,术中取蓝染的SLN病理检查,术后将病理检查结果与腋窝淋巴结转移情况进行比较分析. 结果 47例中5例未见淋巴结及淋巴管蓝染,其余42例找到腋窝淋巴结608个,阳性18例168个,阴性24例440个;SLN共78个,阳性16例29个,阴性26例49个.SLN的检出率89.4%,准确性95.2% ,特异性100%,敏感性88.9%,假阴性率11.1%,假阳性率0. 结论 SLN活检反应腋窝淋巴结的肿瘤转移状况,可以用于术中确定是否行ALND.     

Sentinel lymph node dissection provides axillary control equal to complete axillary node dissection in breast cancer patients with lobular histology and a negative sentinel node

OBJECTIVE: Invasive lobular carcinoma (ILC) presents special challenges to treating physicians because of the diffuse infiltrative growth pattern. As sentinel lymph node dissection (SLND) is rapidly replacing axillary lymph node dissection (ALND) in the management of patients with early-stage breast cancer, we sought to evaluate the safety of SLND in providing axillary control in breast cancer patients with lobular histology and a negative sentinel node. METHODS: We identified 239 patients with T1-2,N0,M0 lobular breast cancer from the prospective databases of 2 institutions; all were treated between March 1994 and December 2003. RESULTS: A total of 202 patients had SLND and 37 had SLND followed by ALND. There was no significant difference between the 2 groups with respect to tumor size, presence of lymphovascular invasion, estrogen receptor (ER)/progesterone receptor (PR) and HER-2/neu status, type of breast surgery, margin status, or nuclear grade. Use of chemotherapy, radiation, and hormonal therapy was not significantly different between groups. At a median follow-up of 48 months in the ALND group and 26 months in the SLND group (range 6 to 80 months), none of the 202 patients in the SLND group had experienced an axillary recurrence, while 2 (5.4%) of the 37 patients who underwent ALND had experienced an axillary recurrence. CONCLUSIONS: SLND provided axillary control equivalent to that of ALND for patients with lobular breast cancer. SLND alone appears to be adequate axillary management of patients with lobular breast cancer and a negative sentinel node.     

Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women

Background We prospectively compared the sensory morbidity and lymphedema experienced after sentinel node biopsy (SLNB) and axillary dissection (ALND) over a 12-month period by using a validated instrument. Methods Patients undergoing breast-conserving therapy completed the Breast Sensation Assessment Scale (BSAS) at baseline and 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to compare ALND and SLNB over the 12-month period. Upper- and lower-arm circumference measurements at baseline and 12 months were used to assess lymphedema. Results SLNB was associated with substantial sensory morbidity, although significantly less than ALND, over time on all four subscales and the summary score. A statistically significant improvement in sensory morbidity occurred for both groups in the first 3 months, with no further change thereafter. For both types of axillary surgery, younger patients had significantly higher BSAS scores than older patients. There was no significant difference in arm circumference between patients with SLNB and ALND at 12 months. Conclusions Among women undergoing breast-conserving therapy, SLNB has significant sensory morbidity, although approximately half that of ALND. Sensory morbidity improves in the first 3 months after surgery, but patients continue to report sensory morbidity at 1 year. Longitudinal follow-up is required to further assess lymphedema.     

乳腔镜前哨淋巴结活检术的临床应用

目的 探讨经乳腔镜前哨淋巴结活检的可行性及应用前景。方法 应用亚甲蓝染色法检测62例乳腺癌患者的前哨淋巴结(SLN)。在乳腔镜下切除SLN,随后行乳腔镜腋窝淋巴结清扫,SLN、腋窝淋巴结同时行HE染色,评价SLN检出率及假阴性率。结果 62例患者61例检出前哨淋巴结,成功率98．4％。无腋窝淋巴结转移者35例,转移27例,假阴性率0。结论 乳腔镜前哨淋巴结活检检出率高,美容效果好,并发症低,对于乳腺癌腋窝淋巴结转移有较高的敏感性,可以为绝大多数乳腺癌进行准确淋巴分期。     

The value of sentinel lymph node biopsy in elderly breast cancer patients

BACKGROUND: Although sentinel lymph node biopsy has been accepted as a useful procedure for certain breast cancer patients, the value of this procedure in the elderly remains unknown. We undertook this study to evaluate changes in adjuvant treatment attributable to sentinel lymph node biopsy. METHODS: A total of 104 patients > or =65 years underwent sentinel lymph node biopsy plus lumpectomy or mastectomy for the treatment of clinically node-negative invasive breast cancer. Demographic, pathologic, and treatment data were evaluated using an SAS software package (SAS, Cary, North Carolina). RESULTS: Twenty-nine of 104 patients (28%) had metastatic disease in > or =1 sentinel lymph node. Nonsurgical treatment was modified in 38% of patients because of sentinel lymph node biopsy results. Changes included adjuvant chemotherapy and/or hormonal therapy, adjuvant axillary radiotherapy, and decisions against adjuvant therapy. CONCLUSIONS: These data suggest that sentinel lymph node biopsy in elderly breast cancer patients is beneficial.     

Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy

BACKGROUND: Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. METHODS: Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. RESULTS: Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). CONCLUSIONS: The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.     

The effect of prior breast biopsy method and concurrent definitive breast procedure on success and accuracy of sentinel lymph node biopsy

Background It has been suggested that sentinel lymph node (SLN) biopsy for breast cancer may be less accurate after excisional biopsy of the primary tumor compared with core needle biopsy. Furthermore, some have suggested an improved ability to identify the SLN when total mastectomy is performed compared with lumpectomy. This analysis was performed to determine the impact of the type of breast biopsy (needle vs. excisional) or definitive surgical procedure (lumpectomy vs. mastectomy) on the accuracy of SLN biopsy. Methods The University of Louisville Breast Cancer Sentinel Lymph Node Study is a prospective multi-institutional study. Patients with clinical stage T1–2, N0 breast cancer were eligible. All patients underwent SLN biopsy and completion level I/II axillary dissection. Statistical comparison was performed by χ² analysis. Results A total of 2206 patients were enrolled in the study. There were no statistically significant differences in SLN identification rate or false-negative rate between patients undergoing excisional versus needle biopsy. The SLN identification and false-negative rates also were not statistically different between patients who had total mastectomy compared with those who had a lumpectomy. Conclusions Excisional biopsy does not significantly affect the accuracy of SLN biopsy, nor does the type of definitive surgical procedure. Presented at the 54th Annual Meeting of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

Regional recurrence in the era of sentinel lymph node biopsy

Background

The incidence of all-location regional recurrence after sentinel lymph node biopsy is not well documented. This study attempts to identify risk factors.

Methods

A prospectively maintained database was queried to identify patients with a regional recurrence of breast cancer after a first operation for invasive unilateral breast cancer. Patients with regional recurrence were compared with those alive and disease free at 5 years.

Results

Twenty-one of 1,060 patients (2%) experienced a regional recurrence. Most patients (95%) underwent sentinel lymph node biopsy as their axillary staging. Those with regional recurrences had larger tumors (P < .001), higher stage disease (P < .001), more estrogen receptor– and triple-negative breast cancers (P < .001), and more positive lymph nodes (P = .007). Mastectomy (P = .001) and receipt of neoadjuvant and/or chemotherapy (P < .001) were more common among those with regional recurrences.

Conclusions

Regional recurrence of breast cancer occurs infrequently. Risk factors include high-risk cancers, higher stage at presentation, nodal involvement, and need for therapies reflecting higher risk biology.     

男性乳腺癌前哨淋巴结活检11例分析

目的 以亚甲蓝注射液为示踪剂检测男性乳腺癌前哨淋巴结,并根据活检及腋窝淋巴结清扫结果评价前哨淋巴结活检在男性乳腺癌治疗中的应用价值.方法 将郑州大学第一附属医院乳腺外科2010年3月-2014年12月收治的男性乳腺癌患者11例入组,临床分期为cT1 ～ T2N0M0.使用亚甲蓝注射液为示踪剂,给予11例患者前哨淋巴结活检,同时给予腋窝淋巴结清扫.结果 11例男性乳腺癌患者,10例检出前哨淋巴结,检出率为90.9％(10/11).前哨淋巴结1～3枚,平均1.8枚.非前哨淋巴结8～14枚,平均10.5枚.1例未检出患者排除分析.10例前哨淋巴结活检成功的患者中6例转移(6/10);前哨淋巴结未转移而非前哨淋巴结转移的患者1例(1/10).本组研究中前哨淋巴结对腋窝淋巴结状况的符合率(准确性)为90％(9/10);灵敏度为100％(6/6)％;准确率为60％(6/10).结论 使用亚甲蓝注射液行前哨淋巴结活检能够准确预测男性乳腺癌腋窝淋巴结的转移情况,可作为早期男性乳腺癌评估腋窝分期的可靠手段.