乳癌哨兵淋巴结检测临床应用

目的：探讨乳癌哨兵淋巴结活检预测腋窝淋巴结转移状态的可靠性.方法：本组为2000年11月至2004年2月我院收治的140例乳癌患者.术中应用国产亚甲蓝注射液4～6 ml肿瘤上、外、下半圆形皮下连续注射,134例行乳癌改良根治术或患侧乳腺区段切除加腋窝淋巴结清扫术.术后解剖蓝染淋巴管,沿着色淋巴管找到蓝染的哨兵淋巴结.哨兵淋巴结及腋窝淋巴结常规行石蜡病理切片检查.5例行乳腺区段切除加哨兵淋巴结活检,1例行全乳切除加哨兵淋巴结活检（冰冻、石蜡病理检查SLN转移阴性）,未行全腋窝淋巴结清扫.结果：140例患者中136例检出哨兵淋巴结,检出率97.14%,灵敏度 88.71%,准确率94.31%,阴性预测值89.71%,假阴性率11.29%,仅哨兵淋巴结阳性7例.结论：应用亚甲蓝注射液淋巴结着色方法行乳癌哨兵淋巴结活检可以准确地预测腋窝淋巴结转移状态.

Clinical application of sentinel lymph node biopsy in breast carcinoma

Objective:To evaluate feasibility and accuracy of lymphatic mapping of sentinel lymph node biopsy for predicting axillary lymph node status in patients with breast carcinoma.Methods:140 patients with primary breast carcinoma were enrolled.Mapping procedures were performed using methylene blue(4-6 ml) subcutaneous injection above,below and outside around the primary tumor followed by modified radical mastectomy or lumpectomy with axillary lymph node dissection(134 cases).The blue lymphatic vessels were followed to find the blue sentinel lymph nodes.All the sentinel lymph nodes and axillary lymph nodes were examined by hematoxylin eosin(HE) staining of paraffin section after operation.Six cases were sentinel lymph node metastases negative,examined by intraoperative frozen section and paraffin section HE staining after operation without axillary lymph node dissection.Results: The overall positive rate of sentinel lymph node was 97.14%(116 of 120 cases).The sensitivity was 88.71%,accuracy was 94.31%,negative predictive value was 89.71% and false negative rate was 11.29%.Seven cases had sentinel lymph node metastases only.Conclusion:The results suggest that the sentinel lymph node biopsy using methylene blue is an accurate predictor of axillary lymph node status in patients with breast carcinoma.