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。

Sentinel lymph node biopsy in breast cancer

Objective To evaluate the accuracy of sentinel lymph node biopsy (SLNB) to predict the axillary lymph node status in breast cancer patients and its clinical significance. Methods Seventy patients with clinical TNM status T 1 2 N 0M 0 underwent sentinel lymph node biopsy using Tc 99m sulfur colloid radiotracer and gamma probe, which was followed by standard axillary dissection. SLNB was compared with standard axillary dissection for its ability to reflect the final pathological status of the axillary nodes. The SLNs that were tumor negative in conventional HE staining were further evaluated using immunohistochemical stains for CK8, CK19 and KP 1 antibodies. Results The sentinel lymph node (SLN) was successfully identified in 67 (95 7%) out of 70 patients. The number of sentinel nodes harvested ranged from 1 to 5 (average 1 6). The nonsentinel nodes ranged from 5 to 20 (average 12 3). Of the 67 patients, 29 (43 3%) had histologically positive axillary lymph nodes. SLN was positive in 24 patients with metastasis (35 8%), and in 7 patients without metastasis (10 4%). In 5 patients, SLN was negative for tumor with positive nodes. The accuracy of sentinel lymph node biopsy to predict the axillary lymph node status was 92 5% and the false negative rate was 7 5%. For tumors with diameter less than or equal to 2 cm, the accuracy was 100% 65 SLNs that were negative for HE stain were also non reactive to immunostain for CK8 and CK19 antibody. Conclusions SLNB can accurately predict the axillary lymph node status in most of breast cancer patients. The accuracy is about 100% in patients with T 1 lesions. Immunohistochemical staining at the same level of HE stain can not increase the detection of lymph node micrometastasis.