乳腺癌前哨淋巴结活检指导腋窝淋巴结清扫

目的探讨前哨淋巴结活检（SLNB）对乳腺癌腋窝淋巴结（ALN）转移状态的预测价值,为指导乳腺癌患者是否行腋窝淋巴结清扫（ALND）提供科学依据。方法2005～2008年本院手术治疗的乳腺癌患者36例患者,采用术前2 h注射99M锝-右旋糖苷（99M Tc-dx）1 ml于肿瘤周围腺体内和术中1%亚甲蓝2 ml（总剂量）四点法注射于肿瘤覆盖皮肤之皮内,术中前哨淋巴结活检,随后行包括ALND的不同方式的根除术。所有前哨淋巴结（SLN）术中冷冻病理检查为单切片HE染色,所有SLN和非SLN均再行多层切片HE染色及免疫组织化学病理学检查。结果根据术中切片病理和术后腋窝淋巴结病理,SLN检出成功率为94.4%（34/36）;SLN预测ALN转移的准确性为94.1%（32/34）,灵敏度为85.7%（12/14）,特异性为100%（20/20）,假阴性率为14.3%（2/14）,总的阳性、阴性预测值分别为100%（12/12）和90.9%（20/22）。与单切片HE染色相比,多层切片HE染色和免疫组织化学检查使灵敏度提高至92.9%（13/14）,假阴性率降低至7.14%（1/14）。结论亚甲蓝法和放射性示踪法联合应用能准确检测出SLN,SLN能反映腋窝淋巴结的状态。术中多层切片HE染色可降低前哨淋巴结假阴性率。

The role of sentinel lymph node biopsy on advising axillary lymph node dissection in breast cancer.

Objective To study the clinical value of sentinel lymph node biopsy（SLNB）to predict axillary lymph node metastasis.So advise to perform axillary lymph node dissection（ALND）in breast cancer operation or not.Methods During 2005～2008,36 cases of breast cancer patients with surgical treatment in our hospital.using technetium 99M-dextran（99M Tc-dx） 1 ml for injection around the tumor glands 2 hours before operation and 1% methylene blue 2ml（total dose） was injected into the skin of cancer location before incision using four-point method.Intraoperative sentinel lymph node biopsy,then eradication of the different ways and ALND.All SLN and non-SLN were re-sliced multi-HE staining and immunohistochemical pathological examination.Results According to intraoperative biopsy and postoperative pathologic axillary lymph node pathology,SLN detection success rate was 94.4%（34/36）,SLN predict accuracy of ALN metastasis was 94.1%（32/34）.Sensitivity was 85.7%（12/14）,specificity was 100%（20/20）,false-negative rate was 14.3%（2 / 14）,the total positive and negative predictive value were 100%（12/12）,and 90.9%（20/22）.Compared with single slice,multi-slice HE staining and immunohistochemical examination increased the sensitivity to 92.9%（13/14）,false-negative rate down to 7.14%（1 / 14）.Conclusion Methylene blue method combination of radioactive tracer method can accurately detect the SLN.SLN can reflect the status of axillary lymph nodes.HE staining of multi-slice technique can reduce the false negative rate of sentinel lymph node.