目的 探討99Tcm-硫膠體和亞甲藍藍染料聯(lián)合進行前哨淋巴結(jié)活檢(sentinel lymph node biopsy, SLNB)在早期乳腺癌中的臨床應(yīng)用價值。
方法 本組201例患者均采用亞甲藍藍染料、99Tcm-硫膠體及兩者聯(lián)合應(yīng)用進行SLNB,并記錄相關(guān)臨床病理數(shù)據(jù),進行統(tǒng)計分析。
結(jié)果 201例患者中成功檢出前哨淋巴結(jié)(sentinel lymph node,SLN) 200例,其中染料法、核素法及聯(lián)合法的SLN檢出率分別為85.4% (170/199)、99.5% (200/201)和99.5% (198/199),染料法的SLN檢出率較低(P<0.001); 準(zhǔn)確率分別為95.3% (162/170)、94.5% (189/200)和98.0% (194/198),差異無統(tǒng)計學(xué)意義(P=0.185); 假陰性率分別為11.3% (8/71)、13.9% (11/79)和5.1% (4/79),差異無統(tǒng)計學(xué)意義(P=0.165)。聯(lián)合法比染料法或核素法能檢出更多的SLN (P<0.001)。相對于聯(lián)合法,染料法和核素法分別有12例和7例SLN癌轉(zhuǎn)移的患者漏檢,漏診率分別為16.0% (12/75)和9.3% (7/75)。
結(jié)論 聯(lián)合法的SLN檢出率較高,能檢出更多的SLN,臨床實踐中應(yīng)盡量采用聯(lián)合法進行SLNB。
引用本文: 田春祥,陳潔,魏兵,歐曉紅,張障,周利娜,龍泉伊,曾荷淋,王強,范雪嬌,王榮,呂青. 核素染料聯(lián)合法在早期乳腺癌前哨淋巴結(jié)活檢手術(shù)中的臨床應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(9): 934-938. doi: 復(fù)制
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- 1. Benson JR, della Rovere GQ. Axilla Management Consensus Group. Management of the axilla in women with breast cancer[J]. Lancet Oncol, 2007, 8(4):331-348.
- 2. de Boer M, van Dijck JA, Bult P, et al. Breast cancer prognosisand occult lymph node metastases, isolated tumor cells, and micrometastases[J]. J Natl Cancer Inst, 2010, 102(6):410-425.
- 3. Giuliano AE. Mapping a pathway for axillary staging:a personal perspective on the current status of sentinel lymph node dissection for breast cancer[J]. Arch Surg, 1999, 134(2):195-199.
- 4. Posther KE, Wilke LG, Giuliano AE. Sentinel lymph node dissection and the current status of american trials on breast lymphatic mapping[J]. Semin Oncol, 2004, 31(3):426-436.
- 5. Lyman GH, Giuliano AE, Somerfield MR, et al. Americansociety of clinical oncology guideline recommendations for sentinellymph node biopsy in early-stage breast cancer[J]. J ClinOncol, 2005, 23(30):7703-7720.
- 6. Goldhirsch A, Ingle JN, Gelber RD, et al. Thresholds for therapies:highlights of the St. Gallen international expert consensus on the primary therapy of early breast cancer 2009[J]. Ann Oncol, 2009, 20(8):1319-1329.
- 7. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer:overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10):927-933.
- 8. American Joint Committee on Cancer. AJCC Cancer Staging Handbook[M]. 7th ed. Chicago, IL:Springer, 2010:347-376.
- 9. Calhoun KE, Hansen NM, Turner RR, et al. Nonsentinel node metastases in breast cancer patients with isolated tumor cells in the sentinel node:implications for completion axillary node dissection[J]. Am J Surg, 2005, 190(4):588-591.
- 10. Cserni G, Bianchi S, Vezzosi V, et al. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study[J]. Pathol Oncol Res, 2007, 13(1):5-14.
- 11. Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe[J]. Surg Oncol, 1993, 2(6):335-339.
- 12. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer[J]. Ann Surg, 1994, 220(3):391-401.
- 13. Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer[J]. Breast Cancer Res Treat, 2006, 95(3):279-293.
- 14. Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection[J]. Surg Oncol, 2010, 102(2):111-118.
- 15. Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer:The ALMANAC trial[J]. J Natl Cancer Inst, 2006, 98(9):599-609.
- 16. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer[J]. N Engl J Med, 2003, 349(6):546-553.
- 17. 左文述, 于志勇, 鄭剛. 乳腺癌前哨淋巴結(jié)活檢研究的現(xiàn)狀與展望[J]. 外科理論與實踐, 2011, 16(1):14-18.
- 18. 鄭剛, 楊靖, 左文述, 等. 中國乳腺癌前哨淋巴結(jié)活檢驗證階段研究結(jié)果的系統(tǒng)評價[J]. 中華醫(yī)學(xué)雜志, 2011, 91(6):361-365.
- 19. 賀青卿, 姜軍, 楊新華, 等. 乳腺癌淋巴引流途徑的臨床研究[J]. 中華乳腺病雜志(電子版), 2008, 2(2):140-148.
- 20. 唐平, 魏兵, 楊雯娟, 等. 乳腺癌前哨淋巴結(jié)的病理檢測[J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12):1225-1230.
- 21. Silverstein MJ, Lagios MD, Recht A, et al. Image-detected breast cancer:state of the art diagnosis and treatment[J]. J Am Coll Surg, 2005, 201(4):586-597.
- 22. Turner RR, Ollila DW, Stern S, et al. Optimal histopathologic examination of the sentinel lymph node for breast carcinoma staging[J]. Am J Surg Pathol, 1999, 23(3):263-267.
- 23. Brogi E, Torres-Matundan E, Tan LK, et al. The results of frozensection, touch preparation, and cytological smear are comparable for intraoperative examination of sentinel lymph nodes:a study in 133 breast cancer patients[J]. Ann Surg Oncol, 2005, 12(2):173-180.
- 24. Salem AA, Douglas-Jones AG, Sweetland HM, et al. Intraoperative evaluation of axillary sentinel lymph nodes using touchimprint cytology and immunohistochemistry. PartⅡ. Results[J]. Eur J Surg Oncol, 2006, 32(5):484-487.
- 25. 孫慎友, 沈坤煒. 早期乳腺癌初始治療的爭議領(lǐng)域——2011 St. Gallen專家共識[J]. 外科理論與實踐, 2011, 16(6):603-604.
- 26. 王永勝. 乳腺癌前哨淋巴結(jié)活檢:共識與展望[J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(7):505-509.