早期乳腺癌中前哨淋巴结导航的淋巴结群切除的价值

目的]比较腋窝前哨淋巴结（SLN）导航的淋巴结群切除与单纯前哨淋巴结活检（SLNB）的优劣，探讨其作为早期乳腺癌外科腋窝处理手段的可行性及临床意义。方法]2003年10月至2009年5月．连续入组305例早期乳腺癌手术病例，术中序贯施行腋窝SLNB、SLN所在淋巴结群切除及全腋窝淋巴结清扫（ALND），比较SLNB与SLN导航的淋巴结群切除活检预测腋淋巴结状态的差异并分析影响淋巴结状态的因素。结果]SLNB成功率为99.34％（303／305）。SLNB假阴性10例，SLNB预测淋巴结状态假阴性率为9．80％（10／102）、敏感性90．20％（92／102）、准确性96．70％（293，303）、阴性似然比0．098。SLN导航的淋巴结群切除活检预测腋淋巴结状态的假阴性率为1．96％（2／102）、敏感性98．04％（100／102）、准确性99．34％（301／303）、阴性似然比0．020。淋巴结状态与肿瘤大小、脉管浸润、组织学分级及Her-2状态相关（P〈0．05）。结论]以腋窝SLN导航的淋巴结群切除替代ALND治疗早期乳腺癌较单纯SLNB更具安全性及应用价值。结合肿瘤大小、脉管浸润、组织学分级及Her-2状态有助于更准确地指导腋窝淋巴结处理方式.

Value of Sentinel Lymph Node Navigating Axillary Group Lymphadenectomy in Early Breast Cancer

Purpose] To explore the ideal surgical axillary management for early breast cancer, to clarify whether substitution of simple sentinel node biopsy （SLNB） with axillary sentinel node （SLN） navigating axillary group lymphadenectomy could induce significant reduction of false negative rate. Methods] From October 2003 to May 2009, 305 consecutive cases with early breast cancer were enrolled. All those patients underwent axillary SLNB first, followed by SLN navigating group lymphadenectomy, and a complete axillary nodes dissection （ALND）. The difference of nodes status predicting value between SLN navigated group lymphadenectomy and SLNB was compared. Also the factors concerned with nodes status were analyzed. Results] SLNs were identified in 303 of 305 cases （99.34%）. There were 10 false negatives occurred with SLNB, resulting in false-negative rate of 9.80%, sensitivity of 90.20% and accuracy of 96.70% in predicting axillary nodes status. Correspondingly, result from SLN navigated group lymphadenectomy revealed false-negative rate of 1.96%, sensitivity of 98.04%, and accuracy of 99.34%. The negative likelihood ratio of above two methods were 0.098 and 0.020, respectively. Axillary nodes status was statistically correlated with tumor size, vascular involvement, histological grade and Her-2 status. Conclusionsl Substitution of ALND with SLN as navigating group lymphadenectomy in early breast cancer displayed a priority for safety and practicability compared with simple SLNB. Comprehensive view of tumor size, lymphovascular invasion, histological grade and Her-2 status will be helpful for axilla management.