乳腺癌前哨淋巴结活检的可行性及临床应用价值

目的 探讨前哨淋巴结(sentinel Iymph node,SLN)定位和活检(SLNB)的可行性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52例临床查体及B超检测ALN阴性的乳腺癌患者,术中在肿瘤周围注射亚甲蓝进行SLN定位和活检。对常规病理检查阴性的SLN再行免疫组化检测。结果 SLNB的检出成功率为92.3％(48/52),准确率为97.9％,假阴性率为4.8％,敏感度为95.2％,特异度为100％。SLN是惟一被证实有肿瘤转移的淋巴结者占66.7％(14/21)。免疫组化检测使SLN肿瘤转移的阳性率提高了4.1％。结论乳腺癌SLNB技术是可行的,应用亚甲蓝淋巴定位方法进行的SLNB可以准确预测临床及B超检查ALN阴性的乳腺癌患者的ALN转

Feasibility and clinical value of sentinel lymph node biopsy in patients with breast cancer

Objective To study the feasibility of the lymphatic mapping and sentinel lymph node biopsy (SLNB)and the accuracy of SLNB for predicting axillary lymph node(ALN) status in patients with breast cancer. Methods Mapping procedures and SLNB by using methylene blue injected at the cancer site were performed in 52 patients with primary breast cancer and clinically and ultrasonographically negative ALN. All of the SLN was examined using HE stain and pathological examination of the negative SLN was made with immunohistochemical staining. Results SLN were successfully identified in 48 of 52 (92.3%)patients.The accuracy rate of SLNB to predict axillary lymph node status was 97.9% ,with 4.8% false negative rate,95.2% sensitivity and 100% specificity.In 14(66.7%) of 21 cases of pathologically positive ALN.the SLN was the only tumor-involved lymph node identified . The pathological examination with immunohistochemical staining increased the SLN positive rate by 4.1 % . Conclusions This study indicates that the procedure of lymphatic mapping and SLNB in the patients with breast cancer is feasible. Intraoperative lymphatic mapping using methylene blue and SLNB can accurately predict the axillary stutus of primary breast cancer patients with clinically and ultrasonographically negative ALN.