乳晕下亚甲蓝法乳腺癌前哨淋巴结活检术169例应用报告

目的探讨乳晕下注射亚甲蓝示踪法进行前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)在乳腺癌治疗中的意义。方法 2005年1月～2010年3月,对169例(年龄33～70岁,中位年龄45岁)临床腋窝淋巴结阴性的乳腺癌术中乳晕下注射亚甲蓝2 ml行SLNB。SLN病理为阴性的患者,SLNB替代腋窝淋巴结清扫术。结果 163例(96.4%)成功实施SLNB,6例(3.6%)术中未能发现SLN,立即改行腋窝淋巴结清扫术(axillary lymph node dissection,ALND)。行SLNB的163例中,23例术中冰冻报告SLN癌转移,即行ALND;140例冰冻切片检查SLN未见癌转移。6例术后HE染色检查发现SLN存在1枚微转移淋巴结,5例接受ALND,1例拒绝行腋窝淋巴结清扫。135例SLNB代替ALND者中位随访时间16个月(3～62个月),均未发现腋窝淋巴结转移。结论亚甲蓝法SLNB安全、有效、简便易行,SLNB阴性的患者,可以替代ALND。

Clinical Value of Subareolar Injection of Methylene Blue in Sentinel Lymph Node Biopsy for Breast Cancer:Report of 163 Cases

Objective To evaluate the efficacy of sentinel lymph node biopsy（SLNB） by using subareolar injection of methylene blue in the management of breast cancer. Methods Form January 2005 to March 2010,totally 169 patients with breast cancer（median age 45 years old,ranged 33-70 years old） with negative axillary lymph nodes received subareolar injection of methylene blue（2 ml） for SLNB.SLNB was performed instead of axillary lymph nodes dissection（ALND） on the patients who had negative SLN.Results The SLNB was completed successfully in 163 of the patients（96.4%）;in the other 6 cases（3.6%）,no SLN was detected,and thus ALND was carried out.In the 163 cases who received SLNB,SLN metastasis was found in 23 cases,which then underwent ALND as well.After the operation,HE staining showed lymph nodes micrometastasis in 6 patients;5 of them therefore received ALND（the other patient refused any further operation）.Totally 135 patients had the SLNB instead of ALND,these patients were followed up for 16 months（ranged from 3 to 62 months）,during which no axillary metastasis was detected.Conclusions Subareolar injection of methylene blue is effective,safe,and convenient for the treatment of patients with negative SLNB.It is a good alternative for ALND.