乳腺癌哨位淋巴结临床意义的研究

目的 :探讨一种在不降低乳腺癌分期准确性的前提下缩小手术的范围的腋窝淋巴结手术方法。方法 :使用专利蓝和美蓝对 1999年 4月～ 2 0 0 0年 4月我院外科收治的 73例临床查体腋窝淋巴结阴性的乳腺癌患者进行哨位淋巴结活检术 (sentinellymphnodebiopsy ,SLNB)。结果 :共成功地确定了 71例( 97.7% )患者的哨位淋巴结 (SLN) ,SLNB的假阴性率为 11.5% ,准确率为 95.8%。患者的年龄、肿瘤大小、肿瘤部位、注射的染料类型及是否活检和术前化疗对成功率和假阴性率无影响。术中印片细胞学检查的准确率为 92 .1% ,假阴性率为 10 % ,假阳性率为 7.1% ;术中快速病理检查准确率为 98 7% ,假阴性率为 5% ,假阳性率为 0 %。免疫组化未发现常规病理检查阴性的SLN有阳性结果。结论 :SLNB能够准确的预测腋窝淋巴结的转移状况 ,在缩小手术范围、减轻患者术后并发症的同时 ,保证了腋窝淋巴结分期的准确性 ;美蓝与专利蓝相比同样可以成功地确定SLN ;术中快速病理检查和印片细胞学检查可以准确的判断SLN的病理状态 ,但也存在一定的假阴性率

The Study of Sentinel Lymph Nodes Biopsy in Breast Cancer

Objective:To study a method which can minimize the extent of axillary dissection, and furthermore determine the accurate status of axillary.Methods:Seventy three patients treated with sentinel lymph nodes biopsy(SLNB) in Shandong Cancer Hospital were studied using Patent Blue V or methylthionium.Results: SLN were successfully identified in 71 of 73 (97.7%) patients, The accuracy rate of SLNB to predict axillary lymph node status was 95.8% (71/73), with 11.5% false negative rate.No significant correlation was found between successful identification of SLN or false negative results and the size, location, or histological type of the primary tumor,patients' age, the type of dye or prior biopsy. The accuracy rate of intraoperative imprint cytology examination of SLN was 92.1%, with false negative rate of 10.0% and false positive rate of 7.1%. The accuracy rate of frozen section examination of SLN was 98.7%, with false negative rate of 5% and false positive rate of 0. No positive result was found in IHC of SLN. Conclusions: SLNB could predict the axillary status of breast cancer patients accurately, improve the accuracy of the axillary staging of breast cancer and decrease the extent of surgery and postoperative complication. Methylthionium has the same result in identifying SLN as patent blue V. There is a learning curve in the successful rate of SLNB. Intraoperative rapid frozen pathology and imprint cytology could accurately determine the status of SLN rapidly, but there were still some false negative results.