| 乳腔镜下应用核素联合染料示踪法对新辅助化疗后乳腺癌患者行前哨淋巴结活检的研究(附41例报告) |
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| 引用本文： | 郭贵龙,张毅,范林军,杨新华,姜军.乳腔镜下应用核素联合染料示踪法对新辅助化疗后乳腺癌患者行前哨淋巴结活检的研究(附41例报告)[J].解放军医学杂志,2010,35(3). |
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| 作者姓名： | 郭贵龙 张毅 范林军 杨新华 姜军 |
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| 作者单位： | 1. 温州医学院附属第一医院乳腺疾病中心,浙江温州,325000
2. 第三军医大学西南医院乳腺中心,重庆,400038 |
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| 摘 要： | 目的 在乳腔镜下采用核素联合染料示踪法对新辅助化疗后的乳腺癌患者行前哨淋巴结活检(SLNB),探讨通过前哨淋巴结(SLN)对腋窝淋巴结内癌细胞转移情况进行预测的可行性.方法 选择行新辅助化疗2～4个疗程后的乳腺癌患者41例,术前15～18h在肿块或活检腔周围分4点注射~(99)Tc~m标记的硫胶体0.5～1.0mCi(1Ci=3.7×10~(10)Bq),术中在同样部化皮下注射美蓝4～6ml.使用γ探测仪在存在高放射活性的部位进行体表定位,腋窝注射溶脂剂,吸脂后,乳腔镜下行SLNB,然后行腋窝淋巴结清扫.将检出的淋巴结制成石蜡切片行常规病理检查,将结果显示有癌细胞转移的淋巴结确定为转移阳性;对病理检查显示为转移阴性的SLN进一步采用免疫组化法检测CK19的表达.计算采用SLN进行预测的准确率、敏感性、特异性、假阴性率和假阳性率.结果 41例患者中,39例患者(95.12%)检出SLN,共126枚,每例平均3.07(1～5)枚.病理检查显示,18例患者的SLN转移阳性(均为真阳性),21例SLN转移阴性(其中20例为真阴性,1例为假阴性).SLN对腋窝淋巴结内癌细胞转移情况的预测准确性为97.43%,敏感性为94.74%,特异性100%,假阴性率为5.26%,假阳性率0%.免疫组化法检测显示,1例病理检查显示转移阴性的SLN内CK19表达阳性.所有患者均对SLNB术后的美容效果较为满意.结论 乳腔镜下应用核素联合染料示踪法能提高SLN的检出率,且具有微创、美容的优点.通过SLN内癌细胞转移情况能够较为准确地预测新辅助化疗后乳腺癌患者腋窝淋巴结内癌细胞的转移情况.
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| 关 键 词： | 乳腺肿瘤 前哨淋巴结活组织检查 内窥镜 染色与标记 |
Endoscopic sentinel lymph node biopsy with combined methylene blue and ~(99)Tc~m-sulfur colloid tracing in patients with breast cancer after neoadjuvant chemotherapy (a report of 41 cases) |
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| GUO Gui-long,ZHANG Yi,FAN Lin-jun,YANG Xin-hua,JIANG Jun. Center for Breast Disease,First Affiliated Hospital of Wenzhong Medical College,Wenzhou,Zhejiang ,China.Endoscopic sentinel lymph node biopsy with combined methylene blue and ~(99)Tc~m-sulfur colloid tracing in patients with breast cancer after neoadjuvant chemotherapy (a report of 41 cases)[J].Medical Journal of Chinese People's Liberation Army,2010,35(3). |
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| Authors: | GUO Gui-long ZHANG Yi FAN Lin-jun YANG Xin-hua JIANG Jun Center for Breast Disease First Affiliated Hospital of Wenzhong Medical College Wenzhou Zhejiang China |
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| Institution: | GUO Gui-long,ZHANG Yi,FAN Lin-jun,YANG Xin-hua,JIANG Jun. Center for Breast Disease,First Affiliated Hospital of Wenzhong Medical College,Wenzhou,Zhejiang 325000,China |
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| Abstract: | Objective To evaluate the feasibility of using endoscopic sentinel lymph node biopsy (SLNB) in surveying metastasis of cancer cells to axillary lymph nodes in patients with breast cancer after neoadjuvant chemotherapy (NAC) by means of combined methylene blue and 99Tcm-sulfur colloid tracing. Methods Forty-one patients with breast cancer, who preoperatively received neoadjuvant chemotherapy for 2-4 courses, underwent endoscopic SLNB. 99Tcm-sulfur colloid (0.5-1.0mCi) was peritumoral injected at 4 sites 15-1... |
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| Keywords: | breast neoplasms sentinel lymph node biopsy endoscopes staining and labeling |
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