前哨淋巴结活检治疗乳腺癌.DOCVIP

临床医学论文-前哨淋巴结活检治疗乳腺癌 ?????? 作者：欧阳永忠，左朝晖，汤明，张理 【摘要】? 目的? 探讨乳腺癌前哨淋巴结活检术(SLNB)的可行性和前哨淋巴结是否能够准确预测乳腺癌的腋窝淋巴结转移状况。方法? 应用美蓝注射乳腺癌肿周围进行前哨淋巴结定位和活检。本组38例临床上未扪及腋窝淋巴结的乳腺癌患者在术中癌周注射1%亚甲蓝溶液4ml，15min后行SLNB并独立送检，之后完成计划手术。结果? SLN检出36例，检出成功率94.74%(36/38)，SLN定位敏感性95.24%(20/21)，假阴性率4.76%(1/21)。结论? SLNB简单易行，能较为准确地预测乳腺癌的腋窝淋巴结转移状况，在乳腺癌的手术治疗中具有重要的临床意义。 　　【关键词】? 乳腺肿瘤；淋巴结切除术；前哨淋巴结活组织检查??? 　　The clinical significance of sentinel lymph node biopsy in breast cancer 　　【Abstract】? Objective? To identify the feasibility of the sentinel lymph node biopsy (SLNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary lymph node.Methods? From June 2001 to July 2005,38 patients with breast cancer were evaluated at the Hunan Province Tumor Hospital.Lymphatic mapping was performed using Methylene Blue.Any bluestained node resection after SLN biopsy. Subsequently,all SLN and ALN were examined by both H＆E staining and immunohistochemical staining for cytokeratin.Results?The SLN was successfully identified in 94.74% (36/38) cases.The sensitivity of SLNB using Methylene Blue in this study was 95.24% (20/21),and false negative rate 4.76% (1/21).Conclusion?SLNB using Methylene Blue can predict the status axillary lymph nodes reliably,the method can be used widely in clinical study because of its convenience and efficiency. 　　【Key words】? breast cancer;axillarys lymph node dissection;sentinel lymph node biopsy ??? 近年来，乳腺癌治疗的理念发生了很大的变化，前哨淋巴结活检（sentinel lymph node biopsy，SLNB）能准确地评估区域淋巴结的转移状况，从而避免在腋窝淋巴结阴性乳腺癌中行腋窝淋巴结清扫（axillarys lymph node dissection，ALND）术。我院2001年6月～2005年7月对38例临床上未扪及腋窝淋巴结的乳腺癌患者进行SLNB，总结如下。 　　1? 资料与方法 　　1.1? 一般资料? SLNB组38例，均为女性，年龄28～66岁，平均（48.36±6.28）岁，其中肿瘤位于外上象限24例，外下象限8例，内上象限2例，内下象限4例。肿瘤直径1.0～5.0cm，平均(3.25±0.82)cm。术前肿块穿刺细胞学检查确诊28例，术中肿块切除冰冻切片确诊10例。行改良根治术26例，标准根治术10例，单纯乳腺切除加腋窝淋巴结切除2例。术后病理诊断：浸润性导管癌20例，单纯癌16例，髓样癌2例。 　　1.2? 前哨淋巴结定位活检方法? 手术中于肿瘤周围或活检后的切口周围腺体组织内注入1%亚甲蓝溶液4ml，15min后于胸大肌外侧缘切开皮肤并分离，寻找蓝染淋巴管并由此解剖至蓝染淋巴