乳腺癌内乳淋巴结病理状态的再认识：附229例内乳淋巴结活检报告

目的探索内乳淋巴结活检对乳腺癌分期、治疗和预后的价值。方法对229例乳腺癌行各式根治术时，经肋间隙行内乳淋巴结定位及活检。结果220例经肋间隙内乳淋巴结活检成功，内乳淋巴结转移者24．45（56／229），腋窝淋巴结转移55．02％（126／229）；腋窝淋巴结转移伴内乳淋巴结转移率为34．13％（43／126），仅内乳淋巴结癌转移率为12．62％（13／107）。腋窝淋巴结癌转移数≥4枚时，内乳淋巴结转移率49．32％（36／73），56例内乳淋巴结转移的淋巴结病理分期（pN）均升高。乳腺癌内乳淋巴结转移与肿瘤部位无显著相关性（x^2=0．661，P=0．719）。内乳淋巴结活检可使70．7％肿瘤位于中央区或内象限的患者避免内乳区照射，使50．7％腋窝淋巴结转移≥4枚者避免内乳区照射。无气胸及出血等与内乳淋巴结活检相关的并发症。结论经肋间隙行内乳淋巴结活检方法简单可行，可提高部分乳腺癌患者pN分期，避免内乳区过度治疗，治疗更具个体化。

Pathological status of internal mammary node in patients with breast cancer: 229 cases

Objective To determine the clinical implications of internal mammary node biopsy for neoplasm stage,treatment,and prognosis in patients with breast cancer.Methods Internal mammary node biopsy via intercostal space was performed in 229 cases of breast cancer.Anatomical location of internal mammary nodes was recorded.Results Internal mammary node biopsy was successfully finished in 220 patients.There were 56 cases (24.45％ ) with internal mammary nodes metastasis,126 cases (55.02％ ) with axillary nodes metastasis,43 cases (34.13％ ) with regional metastases in both the axillary and internal mammary lymph nodes and 13 cases ( 12.62％ ) with internal mammary node metastasis only.Internal mammary node metastasis rate in patients with the number of positive axillary nodes ≥4 was 49.32％ (36/73).pN stage migration was seen in 56 patients with positive internal mammary nodes.There was no statistic relation between internal mammary nodes metastases and tumor location ( x2 =0.661,P =0.719).70.7％ patients with medial/central tumors and 50.7％ patients with the number of positive axillary nodes ≥4 were free from internal mammary node radiotherapy on account of internal mammary node biopsy.There was no complication such as pneumothorax or haemorrhagia.Conclusions Internal mammary node biopsy from intercostal space is a reliable surgical technique and can improve pN stage in some breast cancer patients.With internal mammary node biopsy,patients with a negative internal mammary node can be prevented from radiation to internal mammary nodal areas.